Surgical orbital
decompression is indicated for patients with compressive
optic neuropathy, exposure keratopathy, an uncontrolled elevation of intraocular pressure, globe subluxation, and disfiguring
proptosis secondary to
Graves ophthalmopathy. Controversy exists, however, regarding the selection of surgical technique to achieve orbital
decompression. We compared the results of our combined transnasal endoscopic and transconjunctival approach with those of our combined transnasal endoscopic and transantral approach to orbital
decompression. We conducted a retrospective chart review of patients who had undergone medial- and inferior-wall orbital
decompression from January 1994 through January 2004. During that time, 189 combined medial- and inferior-wall orbital decompressions were performed on 124 patients; 51 combined endoscopic and transantral decompressions were performed on 28 patients, and 138 combined endoscopic and transconjunctival decompressions were performed on 96 patients. Patient demographics and the degree of preoperative
proptosis were statistically equal in the 2 groups. The incidence of
optic neuropathy in the transantral group was significantly higher than the incidence in the entire group (p = 0.03), and the incidence of exposure keratopathy was significantly lower in the transantral group than in the entire group (p = 0.03). Postoperatively, the reduction in
proptosis in the 2 groups was statistically equivalent, but the transconjunctival group had a significantly lower incidence of both infraorbital
hypesthesia (p< 0.0001) and early
rhinosinusitis (p = 0.008). Three cases of globe ptosis and 2 of infraorbital
neuralgia occurred. No cases of visual loss, worsened
optic neuropathy,
diplopia in patients without preexisting
diplopia,
cerebrospinal fluid leak, significant
epistaxis, or periorbital
hematoma were noted. We conclude that combined endoscopic and transconjunctival orbital
decompression offers equivalent efficacy with less postoperative infraorbital
hypesthesia and early
rhinosinusitis than does combined endoscopic and transantral orbital
decompression.