Comparison of 2-wall (medial-lateral) and 3-wall (medial-lateral-floor) orbital decompression for the treatment of compressive optic neuropathy in thyroid-related orbitopathy

In this study, we compared the surgical outcome of 2-wall (medial-lateral) and 3-wall (medial-lateral-floor) orbital decompression in patients with compressive optic neuropathy in thyroid-related orbitopathy refractory to systemic steroid therapy.This study was held in Gazi University School of Medicine Oculoplastic and Orbital surgery department. Between 2004 and 2010, 2 wall or 3-wall orbital decompression performed on 42 patients? 68 eyes referred with compressive optic neuropathy in thyroid-related orbitopathy and results were evaluated retrospectically. Patients were evaluated for colour vision with Ischihara cards, for visual field with Humphrey automatic perimeter also superior opthalmic vein flow velocity calculated and full opthalmological examination performed. Apical crowding was evaluated with orbital CT scan and/or orbital MRI. Preoperative exam results were compared with test results after orbital decompression surgery.2-wall and 3-wall techniques were not superior to each other for colour vision, visual acuity in LogMar and superior opthalmic vein flow velocities (p> 0,05). Visual field parameters of mean deviation and pattern standard deviation and intraocular pressure results were statistically improved in 3-wall group. (p< 0,05). Also retropulsion was seen with 3-wall orbital decompression in higher rates (p< 0,05).As a result, both 2-wall and 3-wall techniques successfully improve visual functions in compressive optic neuropathy. If more reduction of proptosis was needed 3-wall technique could be preferred.