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O.165 Corticotherapy, radiotherapy and surgery in Graves ophthalmopathy
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Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
Abstracts, EACMFS XIX Congress
significantly enhanced the proliferation, IFN-g expression, and cytotoxicity of the T cells. Conclusions: The genetically modified OSCC cells encoding B7H3 enhance the induction of tumor specific immune response.
corneal ulceration and optic neuropathy (100%, 100%, 80% respectively). Conclusions: Integration of three sequential treatment methods: corticotherapy, radiotherapy and surgery resulted in improvement or regression of the most advanced eye changes. Orbital decompression restored vision in 29 previously blind patients.
Thursday, 11 September 2008, 12.00–13.00
Endocrine orbitopathy
O.166 Graves’ ophthalmopathy: calibrated surgical technique
O.164 Bi-coronal approach in endocrine orbitopathy
J. Esteves, H. Rodrigues, E. Carreiro Da Costa, H. Simoes. Centro Hospitalar de Lisboa Central, Lisboa, Portugal
Sala Bianca
D. Poruban, S. Ferkova, J. Cmelo, A. Stebel, M. Chynoransky. Medical Faculty Comenius University, St. Elisabeth’s Insitute of Oncology, Bratislava, Slovakia Objectives: Authors demonstrate advantages of the bi-coronal approach in the surgical treatment of Graves’ orbitopathy along with the value of correct indication and timing on the treatment result. Methods: The retrospective study of the 12 patients with endocrine orbitopathy treated by bi-coronal surgical approach is presented. The group of patients is divided according to the primary aim of surgery and timing of the orbital decompression in general treatment. The criteria are set to assessment of final functional and esthetic results. The extent of orbital surgery is taken into the consideration as well. Results: Acute orbital decompression was indicated in 5 cases. The other 7 patients were operated on for other ophthalmic indications resulting from Graves’ disease. Esthetic and functional results were as expected in 5 of 7 cases. In two cases the vision ability was saved but the esthetic result and other functional results was worse than expected. Conclusion: Bi-coronal surgical approach is safe and satisfactory approach in the orbital decompression. The balance between the size of fenestrations and the extent of orbital fat removal remains the issue for next investigations. O.165 Corticotherapy, radiotherapy and surgery in Graves ophthalmopathy H. Wanyura1 , H. Jastrzebska2 , A. Kaminski1 . 1 Department of Cranio-Maxillofacial Surgery, Medical University of Warsaw, Warsaw, Poland; 2 Department of Endocrinology, The Medical Centre of Postgraduate Education, Warsaw, Poland Objectives: The aim of this study was to present complex treatment of patients with severe Graves ophthalmopathy. Material: Severe active phase was treated with oral prednisone. In 316 cases corticotherapy was withdrawn after 20 weeks. 26 patients with optic neuropathy received methylprednisolone for 7 days followed by oral glucocorticoids. 491 patients were treated with retrobulbar megavoltage radiotherapy 20 Gy combined with oral glucocorticoids which was withdrawn after 12 weeks. Orbital decompression has been performed in 41 patients following previous unsuccesful treatment. Results: Corticotherapy produced favorable effects resulting in significant reduction of ophthalmopathy index 7.4 vs. 4.4 (P < 0.01). However, diminution of proptosis and improvement in ocular motility was not impressive (52%, 50% respectively). Reccurence of active eye disease was noted in 54% of patients during the first year of follow-up. Oral glucocorticoids associated with orbital radiotherapy resulted in similarly favorable outcome as glucocorticoids alone. Ophthalmopathy index decreased significantly: 8.0 vs 4.7 (P < 0.01). The combined therapy, however, reduced treatment time by 30%, and glucocorticoid dosage by 50% respectively. The reccurence rate of active phase occured only in 15% of patients. Orbital decompression produced favorable effects including a significant reduction of the ophthalmopathy index 9.2 vs. 5.4 (P < 0.01) with high effectiveness on proptosis,
Objectives: Graves’ Ophthalmopathy is one of the manifestations of Graves’ Disease, resulting from increased intraorbital fat tissue and hypertrophic extraocular muscles. These changes lead to progressive loss of visual acuity. Several surgical techniques of orbital decompression have been reported, with variable rates of post-operative diplopia. The authors present three cases of surgical decompression of the orbit, through a technique based on the principles applied in the treatment of orbital floor fractures. Methods: Three patients with Graves’ Ophthalmopathy went through a pre-operative Neurophthalmology evaluation, including assessment of Visual acuity, Ophthalmoscopy, Exophthalmometry and Hess Chart. The patients underwent orbital decompression through a calibrated technique of orbital remodelling, consisting of ostectomy of the orbital floor and medial wall, with posterior reconstruction using a titanium mesh, after satisfactory retropulsion of the globe was obtained. The globe position achieved was then reproduced in the second orbit, reconstructing it in a similar way. A new ophthalmologic assessment was done postoperatively, and the results compared with the previous data. Results: Of the three patients, none presented with post-operative diplopia. There was a significant decrease in the degree of ocular protrusion, with results similar to those reported in the literature with other techniques, as well as an increase in visual acuity. Conclusions: Although the number of patients reported is small, not allowing a reliable comparison with the traditional procedures, the results so far suggest that this technique is a successful option for the surgical treatment of patients in risk of visual loss. O.167 Orbital decompression in Grave’s orbitopathy P. Mahy1 , S. Siciliano2 , C. Daumerie3 , A. Boschi4 . 1 OMFS Dept, 2 Service de Stomatologie et Chirurgie Maxillo-Faciale, 3 Service d’Endocrinologie et de Nutrition, 4 Service d’Ophtalmologie, Cliniques Universitaires Saint-Luc, Universit´e Catholique de Louvain, Bruxelles, Belgium Objectives: To examine the outcomes of surgical orbital decompression for Graves’ orbitopathy by two surgeons since 2001 to 2007 within the multidisciplinar center of the University Hospital St-Luc, Brussels, Belgium. Methods: Retrospective analysis of a serie of 24 patients, 44 orbits who underwent uni or bilateral 2 or 3 walls orbital decompression with a technique derived from Wulc et al (1990). Results: Patients were treated according to EUGOGO guidelines (2008). Surgical indication was proptosis in 15/24 patients and optic neuropathy in 9/24. Surgical access was obtained with a coronal approach in 21/24 patients for a bilateral decompression in 20/24 patients. The mean surgical time was 250±69 min (range 120–390). Patients remained in hospital 2.4±1.1 nights after surgery. All eye measurements were performed by the same ophtalmologist (AB). The proptosis decreased from 26.4±4.4 to 21.1±3.8 mm at first control after surgery to 20.8±4.1 mm after 11 months (p < 0.0001 and p < 0.0001); the visual activity increased from 7.7±2.4 to 8.4±2.1 and 8.7±2.3 (NS); the visual activity in patient with preoperative optic neuropathy increased from 6.8±2.6 to 7.6±2.4 and 8.3±2.8 (NS); the intraocular pressure decreased from 22.1±9 to 18.8±2.8 and 16.5±2.7 mmHg (p = 0.08 and p < 0.01; respectively). 62% of patients needed
Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
Abstracts, EACMFS XIX Congress
significantly enhanced the proliferation, IFN-g expression, and cytotoxicity of the T cells. Conclusions: The genetically modified OSCC cells encoding B7H3 enhance the induction of tumor specific immune response.
corneal ulceration and optic neuropathy (100%, 100%, 80% respectively). Conclusions: Integration of three sequential treatment methods: corticotherapy, radiotherapy and surgery resulted in improvement or regression of the most advanced eye changes. Orbital decompression restored vision in 29 previously blind patients.
Thursday, 11 September 2008, 12.00–13.00
Endocrine orbitopathy
O.166 Graves’ ophthalmopathy: calibrated surgical technique
O.164 Bi-coronal approach in endocrine orbitopathy
J. Esteves, H. Rodrigues, E. Carreiro Da Costa, H. Simoes. Centro Hospitalar de Lisboa Central, Lisboa, Portugal
Sala Bianca
D. Poruban, S. Ferkova, J. Cmelo, A. Stebel, M. Chynoransky. Medical Faculty Comenius University, St. Elisabeth’s Insitute of Oncology, Bratislava, Slovakia Objectives: Authors demonstrate advantages of the bi-coronal approach in the surgical treatment of Graves’ orbitopathy along with the value of correct indication and timing on the treatment result. Methods: The retrospective study of the 12 patients with endocrine orbitopathy treated by bi-coronal surgical approach is presented. The group of patients is divided according to the primary aim of surgery and timing of the orbital decompression in general treatment. The criteria are set to assessment of final functional and esthetic results. The extent of orbital surgery is taken into the consideration as well. Results: Acute orbital decompression was indicated in 5 cases. The other 7 patients were operated on for other ophthalmic indications resulting from Graves’ disease. Esthetic and functional results were as expected in 5 of 7 cases. In two cases the vision ability was saved but the esthetic result and other functional results was worse than expected. Conclusion: Bi-coronal surgical approach is safe and satisfactory approach in the orbital decompression. The balance between the size of fenestrations and the extent of orbital fat removal remains the issue for next investigations. O.165 Corticotherapy, radiotherapy and surgery in Graves ophthalmopathy H. Wanyura1 , H. Jastrzebska2 , A. Kaminski1 . 1 Department of Cranio-Maxillofacial Surgery, Medical University of Warsaw, Warsaw, Poland; 2 Department of Endocrinology, The Medical Centre of Postgraduate Education, Warsaw, Poland Objectives: The aim of this study was to present complex treatment of patients with severe Graves ophthalmopathy. Material: Severe active phase was treated with oral prednisone. In 316 cases corticotherapy was withdrawn after 20 weeks. 26 patients with optic neuropathy received methylprednisolone for 7 days followed by oral glucocorticoids. 491 patients were treated with retrobulbar megavoltage radiotherapy 20 Gy combined with oral glucocorticoids which was withdrawn after 12 weeks. Orbital decompression has been performed in 41 patients following previous unsuccesful treatment. Results: Corticotherapy produced favorable effects resulting in significant reduction of ophthalmopathy index 7.4 vs. 4.4 (P < 0.01). However, diminution of proptosis and improvement in ocular motility was not impressive (52%, 50% respectively). Reccurence of active eye disease was noted in 54% of patients during the first year of follow-up. Oral glucocorticoids associated with orbital radiotherapy resulted in similarly favorable outcome as glucocorticoids alone. Ophthalmopathy index decreased significantly: 8.0 vs 4.7 (P < 0.01). The combined therapy, however, reduced treatment time by 30%, and glucocorticoid dosage by 50% respectively. The reccurence rate of active phase occured only in 15% of patients. Orbital decompression produced favorable effects including a significant reduction of the ophthalmopathy index 9.2 vs. 5.4 (P < 0.01) with high effectiveness on proptosis,
Objectives: Graves’ Ophthalmopathy is one of the manifestations of Graves’ Disease, resulting from increased intraorbital fat tissue and hypertrophic extraocular muscles. These changes lead to progressive loss of visual acuity. Several surgical techniques of orbital decompression have been reported, with variable rates of post-operative diplopia. The authors present three cases of surgical decompression of the orbit, through a technique based on the principles applied in the treatment of orbital floor fractures. Methods: Three patients with Graves’ Ophthalmopathy went through a pre-operative Neurophthalmology evaluation, including assessment of Visual acuity, Ophthalmoscopy, Exophthalmometry and Hess Chart. The patients underwent orbital decompression through a calibrated technique of orbital remodelling, consisting of ostectomy of the orbital floor and medial wall, with posterior reconstruction using a titanium mesh, after satisfactory retropulsion of the globe was obtained. The globe position achieved was then reproduced in the second orbit, reconstructing it in a similar way. A new ophthalmologic assessment was done postoperatively, and the results compared with the previous data. Results: Of the three patients, none presented with post-operative diplopia. There was a significant decrease in the degree of ocular protrusion, with results similar to those reported in the literature with other techniques, as well as an increase in visual acuity. Conclusions: Although the number of patients reported is small, not allowing a reliable comparison with the traditional procedures, the results so far suggest that this technique is a successful option for the surgical treatment of patients in risk of visual loss. O.167 Orbital decompression in Grave’s orbitopathy P. Mahy1 , S. Siciliano2 , C. Daumerie3 , A. Boschi4 . 1 OMFS Dept, 2 Service de Stomatologie et Chirurgie Maxillo-Faciale, 3 Service d’Endocrinologie et de Nutrition, 4 Service d’Ophtalmologie, Cliniques Universitaires Saint-Luc, Universit´e Catholique de Louvain, Bruxelles, Belgium Objectives: To examine the outcomes of surgical orbital decompression for Graves’ orbitopathy by two surgeons since 2001 to 2007 within the multidisciplinar center of the University Hospital St-Luc, Brussels, Belgium. Methods: Retrospective analysis of a serie of 24 patients, 44 orbits who underwent uni or bilateral 2 or 3 walls orbital decompression with a technique derived from Wulc et al (1990). Results: Patients were treated according to EUGOGO guidelines (2008). Surgical indication was proptosis in 15/24 patients and optic neuropathy in 9/24. Surgical access was obtained with a coronal approach in 21/24 patients for a bilateral decompression in 20/24 patients. The mean surgical time was 250±69 min (range 120–390). Patients remained in hospital 2.4±1.1 nights after surgery. All eye measurements were performed by the same ophtalmologist (AB). The proptosis decreased from 26.4±4.4 to 21.1±3.8 mm at first control after surgery to 20.8±4.1 mm after 11 months (p < 0.0001 and p < 0.0001); the visual activity increased from 7.7±2.4 to 8.4±2.1 and 8.7±2.3 (NS); the visual activity in patient with preoperative optic neuropathy increased from 6.8±2.6 to 7.6±2.4 and 8.3±2.8 (NS); the intraocular pressure decreased from 22.1±9 to 18.8±2.8 and 16.5±2.7 mmHg (p = 0.08 and p < 0.01; respectively). 62% of patients needed