Surgical management of thyroid eye disease- (TED-) associated morbidity has been plagued by the complex interplay of different operative techniques. Orbital decompression is the well-recognized procedure for disfiguring exophthalmos and dysthyroid optic neuropathy (DON). There are numerous published techniques described for the removal of the orbital bone, fat, or a combination. The diverse studies are noncomparative as they include different indications, stages of disease, and methods of evaluation. Thus, it is difficult to conclude the most efficient decompression technique. To obtain effective and predictable results, it is therefore important to propose a logical and acceptable clinical guideline to customize patient treatment. Herein, we developed an algorithm based on the presence of DON, preoperative existing diplopia, and severity of proptosis which were defined by patient’s disabling symptoms together with a set of ocular signs reflecting visual function or cosmesis. More specifically, we aimed to assess the minimal but effective surgical technique with acceptable potential complications to achieve therapeutic efficacy. Transcaruncular or inferomedial decompressions are indicated in restoring optic nerve function in patients with DON associated with mild or moderate to severe proptosis, respectively. Inferomedial or fatty decompressions are effective to treat patients with existing diplopia associated with mild or moderate to severe proptosis, respectively. Fatty or balanced decompressions can improve disfiguring exophthalmos in patients without existing diplopia associated with mild to moderate or severe proptosis, respectively. Inferomedial or 3-wall decompressions are preferred to address facial rehabilitation in patients associated with very severe proptosis but without preoperative diplopia.

中文翻译：

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甲状腺眼疾病的手术减压策略。

不同手术技术之间复杂的相互作用已困扰着甲状腺疾病（TED-）相关疾病的外科治疗。眼眶减压术是公认的眼球突出症和甲状腺功能异常性视神经病变（DON）畸形的手术。描述了许多公开的技术来去除眼眶骨，脂肪或它们的组合。多样化的研究是不可比较的，因为它们包括不同的适应症，疾病的阶段和评估方法。因此，很难得出最有效的减压技术。为了获得有效和可预测的结果，因此重要的是提出合乎逻辑的和可接受的临床指南以定制患者的治疗方法。在此，我们根据DON的存在，术前存在的复视，眼球突出症的严重程度和严重程度由患者的残疾症状以及一组反映视觉功能或美容的眼部症状定义。更具体地说，我们旨在评估具有可接受的潜在并发症的最小但有效的手术技术，以达到治疗效果。在恢复伴有轻度或中度至重度眼球突出症的DON患者中，视神经管下减压或下颌骨减压分别适用于恢复视神经功能。地下或脂肪减压术可有效治疗分别患有轻度或中度至重度眼球突出症的复视患者。脂肪或平衡减压可分别改善没有现存复视与轻度，中度或重度眼球突出症相关的患者的眼球变形。