Endoscopic Transconjunctival Deep Lateral Wall Decompression for Thyroid-associated Orbitopathy: A Minimally Invasive Alternative: Transconjunctival Endoscopic with Wall Decompression for TAO.

Abstract Purpose To investigate the feasibility, efficacy, and safety of endoscopic transconjunctival transorbital deep lateral wall decompression for thyroid-associated orbitopathy (TAO). Design Prospective single-surgeon interventional case series. Methods Twenty-two patients (39 orbits) diagnosed with TAO without dysthyroid optic neuropathy were enrolled in this study. All the patients underwent endoscopic transconjunctival transorbital deep lateral wall decompression for proptosis reduction. The data, including measurement on exophthalmometry, volumetric change on computerized tomography, and surgery-related complications, were analyzed. Results We observed a proptosis reduction (mean, 3.42±0.87 mm; range, 2.10–5.52 mm) and a corresponding decrease in the bony volume of the greater wing of the sphenoid bone (mean, 1.89±0.81 cm3; range, 0.56–3.79 cm3) postoperatively. Pre-existing diplopia improved in five patients (22.72%). Transient zygomaticotemporal hypoaesthesia developed in all patients while cerebrospinal fluid leakage occurred in one orbit (2.56%). No patient complained of temporal hollowing, oscillopsia, new-onset or worsening diplopia during follow-up. Conclusion Endoscopic transconjunctival transorbital deep lateral wall decompression is an effective and minimally invasive treatment for proptosis reduction in TAO patients. The surgery-related complications with this technique were fewer compared with traditional approaches.