Background Orbital decompression is commonly performed to correct proptosis in patients with Graves’ orbitopathy (GO). In literature, the incidence of new-onset constant diplopia after orbital decompression varies. Few studies have evaluated changes in duction and cyclodeviation after orbital decompression. We evaluated the changes in duction, cyclodeviation, eye position and degree of diplopia after orbital decompression. Methods We retrospectively analysed data from patients who underwent orbital decompression at our hospital between January 2016 and July 2020. Data regarding the type of decompression, eye position, duction, cyclodeviation and level of diplopia according to the Gorman score were recorded. Results Data from 281 eyes/orbits of 156 patients were analysed. Proptosis decreased from 23.8±2.5 to 20.9±2.5 mm. Horizontal and vertical duction range decreased (horizontal d=0.40 and vertical 0.30; p=0.000) after surgery; however, the change was not clinically significant (≤5°). Horizontal deviation changed towards esodeviation (d=−0.45; p=0.000), whereas vertical deviation remained stable (d=0.15; p=0.161). Preoperative cyclotorsion in the primary and downgaze positions changed towards incyclodeviation (primary: d=0.30, p=0.021; downgaze d=0.30, p=0.039). Diplopia improved in 22% (18 patients), whereas new-onset constant diplopia developed in 11% (12 patients). Elevation has an excellent predictive value of causing new-onset constant diplopia when measured preoperatively as <19°, sensitivity 88.0%, specificity 41.7% (area under the curve 0.812 (95% CI 0.660 to 0.963); p=0.000). Conclusion After orbital decompression, incidence of new-onset constant diplopia was 11% and 22% of the patients had partial or complete improvement of their diplopia. The changes in duction, cyclodeviation and horizontal deviation showed a statistical but not clinical difference. Patients with GO and a preoperatively restricted elevation of <19° are at risk of developing new-onset constant diplopia. In addition, preoperative incyclodeviation may worsen after decompression surgery. Data are available on reasonable request.

中文翻译：

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眼眶减压对回旋、旋转和复视的影响


背景 眼眶减压通常用于矫正格雷夫斯眼眶病 (GO) 患者的眼球突出。在文献中，眼眶减压后新发持续复视的发生率各不相同。很少有研究评估眼眶减压后内旋和旋转偏差的变化。我们评估了眼眶减压后的复位、睫状体偏差、眼位和复视程度的变化。方法回顾性分析2016年1月至2020年7月期间在我院接受眼眶减压术的患者资料，记录减压方式、眼位、眼球内收、睫状体偏斜以及根据Gorman评分复视程度等数据。结果 分析了 156 名患者 281 只眼睛/眼眶的数据。眼球突出从23.8±2.5毫米减少到20.9±2.5毫米。术后水平和垂直引导范围减小（水平 d=0.40 和垂直 0.30；p=0.000）；然而，这种变化没有临床意义（≤5°）。水平偏差向内偏差转变（d=−0.45；p=0.000），而垂直偏差保持稳定（d=0.15；p=0.161）。术前主要和下视位置的眼球旋转向内旋旋转转变（主要：d=0.30，p=0.021；下视d=0.30，p=0.039）。 22%（18 名患者）复视得到改善，而 11%（12 名患者）出现新发持续复视。当术前测量为 <19° 时，仰角对于引起新发持续复视具有极好的预测价值，敏感性 88.0%，特异性 41.7%（曲线下面积 0.812（95% CI 0.660 至 0.963）；p=0.000）。结论 眼眶减压术后，新发持续复视发生率为11%，其中22%的患者复视部分或完全改善。 内旋、旋转偏差和水平偏差的变化显示出统计差异，但没有临床差异。患有 GO 且术前仰角受限 <19° 的患者有发生新发持续复视的风险。此外，术前的内旋偏差在减压手术后可能会恶化。可根据合理要求提供数据。