The method of the exophthalmos value predicted calculation when planning the orbital decompression procedure in patients with endocrine ophthalmopathy

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Abstract

BACKGROUND: The most effective method of surgical treatment of lipogenic and mixed forms of edematous exophthalmos is currently the internal orbital decompression. During this surgical procedure, the excessive pathologically altered adipose tissue is removed from the external and the internal surgical spaces of the orbit. Many scientists are developing methods for calculating the volume of orbital fat, but the question on developing a method for predicted exophthalmos after internal orbital decompression, which could be used without attracting additional equipment and software, is easy to learn and does not require a long calculation time, remains actual. This method has to take into account the individual features of the patient’s orbital structure and be used for calculations in the bilateral proptosis correction.

AIM: To develop and evaluate the effectiveness of a new method for calculating the eyeball position after orbital decompression.

MATERIALS AND METHODS: 64 patients (126 orbits) with lipogenic and mixed forms of endocrine ophthalmopathy were examined. All patients underwent internal orbital decompression, during which the orbital fat was removed, the volume of which was calculated according to the developed original method. Patients underwent ophthalmological examination and MSCT before surgery and 6 months after it. .

RESULTS: As a result of orbital decompression in the examined group, a decrease in proptosis was observed in all patients, and the exophthalmos calculated by the method corresponded to the eyeball position in patients in 6 months after surgery. The level of statistical significance of the planned postoperative eyeball position in relation to the actual postoperative exophthalmos calculated according to the Student’s t-test was 0.98 (p > 0.05), that is, it can be argued that the groups do not differ, and no statistically significant differences were found.

CONCLUSIONS: The developed method for calculating the estimated postoperative exophthalmos is effective without using additional software. This technique allows you to achieve a symmetrical eyeball position in the postoperative period and to reduce the risk of complications.

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About the authors

Konstantin A. Konovalov

1586 Military clinical hospital

Email: kkonovalov82@mail.ru

Head of the ophthalmological Department

Russian Federation, Mashtakova street 4, Podolsk, Moscow region, 142110

Dmitrii V. Davydov

Peoples’ Friendship University of Russia; A.I. Evdokimov Moscow State University of Medicine and Dentistry

Email: d-davydov3@yandex.ru
ORCID iD: 0000-0001-5506-6021
SPIN-code: 1368-2453

Dr. Sci. (Med.), Professor, head of Department of Reconstructive and Plastic Surgery with an Ophthalmology Course

Russian Federation, 8, Miklukho-Maklaja street, Moscow,117198; Moscow

Dmitrii Anatolevich Lezhnev

A.I. Evdokimov Moscow State University of Medicine and Dentistry

Author for correspondence.
Email: lezhnevd@mail.ru

Dr. Sci. (Med.), Professor, head of Department of Radiology

Russian Federation, Miklukho-Maklaja street, 8, Moscow, 117198

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Supplementary files

Supplementary Files
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1. Fig. 1. MSCT. 3D reconstruction in the bone mode. Placing a mark on the orbital seam of one of the orbits (arrow)

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2. Fig. 2. MSCT. 3D reconstruction in the bone mode. Alignment of the frontal plane and removal of the data array located behind this plane

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3. Fig. 3. MSCT. 3D reconstruction in soft tissue mode. Noted the zone of entry into the orbit along the bone edge, images outside the circle were excluded from the analysis

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4. Fig. 4. MSCT. 3D reconstruction in soft tissue mode. Measurement of the magnitude of the exophthalmos of the right orbit (AB segment) before surgery and the estimated exophthalmos (AС segment) after surgery

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5. Fig. 5. MSCT. 3D reconstruction in soft tissue mode. The amount of fatty tissue calculated using standard programs MSCT, which must be removed during surgery

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Copyright (c) 2021 Konovalov K.A., Davydov D.V., Lezhnev D.A.

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