Endoscopic orbital decompression with preservation of an inferomedial bonystrut: Minimization of postoperative diplopia

With the increasing sophistication and safety of endoscopic orbital decompr ession, the technique is seen by many as an attractive and less morbid alte rnative to traditional open techniques. This rationale also makes the proce dure more acceptable for individuals considering decompression for cosmetic reasons. As a result, complications such as postoperative diplopia assume greater significance. Preservation of an inferomedial bony strut has been p ostulated to reduce the incidence of postoperative diplopia in transconjunc tival, but not endoscopic, orbital decompression for dysthyroid ophthalmopa thy. We present a consecutive series of 11 subjects (21 eyes) who underwent transnasal endoscopic medial and inferior decompression of the orbits bila terally. All patient charts were reviewed in a retrospective fashion and op hthalmologic, surgical, and cosmetic data were recorded, with callback of p atients with incomplete data sets. All cases were performed under general a naesthesia. Preservation of the strut was possible in 15 of 21 eyes. Visual acuity was preserved or improved in all 21 eyes. Average ocular recession based on Hertel measurements was 3.6 mm and there were no surgical complica tions. New-onset or worsening diplopia was noted postoperatively in 2 of 11 subjects. However, in patients where both struts were preserved, there was zero incidence of postoperative diplopia (0/6). These results indicate tha t preservation of an inferomedial bony strut is not only technically feasib le but also does not compromise the adequacy of decompression. The results also suggest that preservation of the inferomedial bony strut during endosc opic orbital decompression can reduce the incidence of postoperative diplop ia.