• Sebastian Kuechlin, Christine Steiert, Yashar Naseri, Lutz Joachimsen, Markus Gruber, Michael Reich, Daniel Boehringer, Mark Metzger, Juergen Beck, Christian Scheiwe, Wolf A Lagrèze, and Juergen Grauvogel.
• Eye Center, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
• World Neurosurg. 2021 May 1; 149: e1007-e1016.

ObjectiveThe choice of surgical technique in sight-threatening Grave orbitopathy remains controversial. Available data are mostly derived from mixed cohorts with multiple surgical indications and techniques. The authors assessed predictors for visual outcome after standardized pterional orbital decompression for dysthyroid optic neuropathy.MethodsRetrospective analysis of 62 pterional orbital decompressions performed on 40 patients with dysthyroid optic neuropathy.ResultsVisual acuity improved by an average of 3.8 lines in eyes with preoperative visual impairment (95% confidence interval [CI]: 1.8-5.8 lines, P < 0.001) and remained stable in eyes without prior visual impairment (95% CI -1.3 to 1 line, P = 0.81). Proptosis was reduced by an average of 3.1 mm (95% CI 1.8-4.3 mm, P < 0.001). Higher degrees of proptosis were predictive of worse visual outcomes (P = 0.017). New-onset diplopia developed in 2 patients, while previous diplopia resolved after surgery in 6 patients.ConclusionsThis cohort is the largest series of pterional orbit decompressions and the first to focus exclusively on dysthyroid neuropathy. Complication rates were low. Decompression surgery was highly effective at restoring and maintaining visual acuity in patients with dysthyroid optic neuropathy.Copyright © 2021 Elsevier Inc. All rights reserved.

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