To investigate the clinical effect of balanced orbital decompression without marginotomy on thyroid-associated ophthalmopathy (TAO).

A total of 25 patients (40 eyes) diagnosed with TAO in the Department of Ophthalmology of the Third Medical Center of the People′s Liberation Army General Hospital and underwent balanced orbital decompression without marginotomy from January 2021 to January 2023 were collected. Among them, 8 cases (10 eyes) were malesand 17 cases (30 eyes) were females with an average age of (36.4±6.14) years (ranged from 21 to 42 years). All patients underwent balanced orbital decompression without marginotomy. For patients with limited eye movement and restrictive strabismus, they underwent strabismus correction surgery simultaneously during orbital decompression surgery. The gender, age, best corrected visual acuity (BCVA), proptosis, intraocular pressure, eye movement, and diplopia of all patients were examined and recorded before and after surgery for 3 months. The gender, age and eye movement was described by frequency and percentage. The BCVA of patients were expressed as median and interquartile before and after surgery and compared by the Wilcoxon signed rank test. The patient′s proptosis and intraocular pressure conformed to normal distribution, and were described by ±s and compared by paired t-test before and after surgery.

Among 25 patients (40 eyes), the median and interquartile of BCVA was 0.8(0.6, 1.0), 0.8(0.6, 1.0) before and after surgery, respectively. There was a significant difference between them (Z=5.84, P>0.05). Among them, the BCVA of 2 cases (2 eyes) before surgery were both 0.6, which reached 0.8 and 1.0 respectively after surgery. The overall proptosis was 20 to 24 mm and the average proptation was (21.35±1.15) mm before surgery. After surgery for 3 months, the proptosis was 14 to 19 mm, and the average proptation was (16.95±1.47) mm, which significantly reduced by (4.4±1.03)mm than that before surgery (t=4.454, P<0.05). The overall intraocular pressure was (20.8±3.26) mmHg (1 mmHg=0.133 kPa) and (16.95±2.08) mmHg before and after surgery, respectively, which significantly reduced by (3.85±2.21)mmHg than that before surgery (t=5.314, P<0.05). Eight cases (10 eyes) with restricted eye movement without restricted strabismus before surgery had symptoms of diplopia, and their ocular activities had been improved to various degrees after surgery, and the symptoms of diplopia were reduced. There were 6 cases (6 eyes) with restricted eye movement restriction and restrictive strabismus before surgery. After surgery, 5 cases (5 eyes) with normal eye position had no obvious diplopia, and 1 case (1 eye) had intermittent exotropia 15° combined with mild diplopia symptoms after surgery, while did not affect daily activities and reading.

The clinical effects of balanced orbital decompression without marginotomy is obvious, which has a small and invisible skin incision without marginotomy and is suitable for patients with high cosmetic demands, low proptosis and without serious compressive optic neuropathy.