The following is a summary of “Effects of orbital decompression on duction, cyclotorsion and diplopia” published in the November 2023 issue of Ophthalmology by Jellema et al.

Despite its widespread use in treating proptosis associated with Graves’ orbitopathy (GO), orbital decompression’s impact on eye movements and diplopia remains unclear.

Researchers retrospectively assessed changes in duction, cyclodeviation, eye position, and diplopia following orbital decompression.

They analyzed data from patients who had undergone orbital decompression at their hospital (January 2016 and July 2020). Information on the decompression type, eye position, duction, cyclodeviation, and diplopia level based on the Gorman score was documented.

The results showed 281 eyes/orbits from 156 patients. Proptosis decreased from 23.8±2.5 to 20.9±2.5 mm. Both horizontal and vertical ducted ranges showed a decline (horizontal d=0.40 and vertical d=0.30; P=0.000) post-surgery, although the change was not clinically notable (≤5°). Horizontal deviation shifted towards esodeviation (d=−0.45; P=0.000), while vertical deviation remained stable (d=0.15; P=0.161). Preoperative cyclotorsion in primary and downgaze positions changed towards incyclodeviation (primary: d=0.30, P=0.021; downgaze d=0.30, P=0.039). Diplopia improvement was observed in 22% (18 patients), while new-onset constant diplopia developed in 11% (12 patients). Preoperative elevation <19° strongly predicted new-onset persistent diplopia, demonstrating 88.0% sensitivity and 41.7% specificity. (area under the curve 0.812, 95% CI 0.660 to 0.963; P=0.000).

Investigators concluded that orbital decompression caused new-onset constant diplopia in 11% and improved diplopia in 22% of patients, with preoperative restricted elevation and incyclodeviation influencing outcomes.

Source: bjo.bmj.com/content/early/2023/11/27/bjo-2023-323480