Endocrine Abstracts

Since the surgical techniques of orbital decompression have changed considerably due to endoscopic techniques, piezosurgery and navigation indication for orbital decompression have expanded. There two real emergency indications: optic nerve compression (DON) and corneal ulceration. In DON patients decompression is performed if no stable remission can be achieved after two weeks of high dose i.v. steroids. In these patients the medial wall should always be included in the surgical procedure since the prolapse of the medial rectus muscles into the ethmoidal cells provide a safe volume increase in the orbital apex. In cases of corneal ulceration decompression should be performed immediately to prevent corneal scaring and amnion membrane transplantation can be done at the same time. In cases of marked chemosis conjunctival approaches should be prevented. Another relative emergency situation is apical crowding in elder patients with concomitant glaucoma. Since the optic nerve is much more vulnerable in these patients and intraocular pressure is usually poorly controlled due to impaired venous outflow in GO, decompression will lead to significant improvement of optic nerve perfusion. The improvement of venous drainage due to decompression can help to improve therapy resistant inflammatory swelling with surgical decompression. In most of the patients a significant decrease of inflammatory swelling can be observed after decompression. In inactive disease stages decompression can be performed to reduce proptosis. Patients who have no diplopia in primary position prior surgery have to be informed about diplopia risk due to decompression, which is high in case of medial wall decompression and low for lateral wall decompression (5–7%). Lateral wall decompression reduces the risk for the medial wall – the so called balanced decompression is the most widely applied technique with a diplopia risk of about 25%. Inferior nasal approaches have a much high risk (about 60%).