Our goal was to investigate the incidence of postoperative primary gaze
diplopia in patients with thyroid-related orbitopathy (TRO) undergoing deep lateral wall orbital
decompression surgery with intraconal fat debulking in the Jules Stein Eye Institute over a period of 4(1/4) years. Overall 201 orbital
decompression surgeries were performed in 116 patients (23 males, 93 females). All surgeries were performed by two of the authors (R.A.G. and J.D.M.) and in the noninflammatory phase of the disease.
Exophthalmos decreased by an average of 3.4 +/- 2.7 mm from 23.8 +/- 3.2 mm (17-31) to 20.4 +/- 2.5 mm (14-29), p < 0.001, 95% confidence interval (CI) (3.0:3.8). 31% of patients had preoperative primary gaze
diplopia and 28.4% had postoperative primary gaze
diplopia. Thirty (83%) of the 36 patients with preoperative
diplopia had also postoperative
diplopia; 6 (16.7%) of the 36 patients had improvement in
diplopia following deep lateral wall
decompression. Of the 80 (69%) of patients without preoperative
double vision 3 developed postoperative
double vision in primary gaze (2.6% of all patients). These 3 patients were older (56 versus 46 years, p = 0.047), had more limitation in ocular movements (p = 0.017) and achieved more decrease in
proptosis with surgery (6 versus 3.1 mm, p = 0.024). No complications were associated with orbital
decompression. In conclusion deep lateral wall orbital
decompression surgery with intraconal fat debulking is associated with a low rate (2.6%) of new-onset primary gaze
diplopia. Some patients (5.2%) with preoperative
diplopia actually had improvement in
diplopia postoperatively. This surgery is effective in reduction of congestion and
exophthalmos, and is not associated with detrimental effects on visual acuity.