Comparison of Transconjunctival and Transnasal approaches for orbital decompression: A randomized controlled trial

Abstract

Abstract Purpose To compare the effectiveness of endoscopic orbital decompression by two surgical approaches for thyroid-associated ophthalmopathy (TAO). Methods A prospective, randomized controlled trial was performed on 48 moderate-to-severe or sight-threatening TAO orbits. All patients, who were randomly assigned into transconjunctival group or transnasal group, underwent endoscopic orbital decompression according to the surgical design. Clinical and radiological data were collected at baseline and 3 months after surgery by a masked investigator. The main outcome was the effective rate. If the postoperative proptosis measured by computed tomography (CT) was below 18 mm or the value of proptosis reduction was over 8 mm, it would be defined as effective. The secondary outcomes included surgical accuracy, best-corrected visual acuity (BCVA), ocular motility grade, diplopia grade, and safety. Results 48 orbits of 41 patients were enrolled in the study, with 24 orbits each in transconjunctival and transnasal group. The effective rate was 87.5% in the transconjunctival group and it was 79.2% in the transnasal group (P = 0.087). The proptosis reduction was 5.38 ± 2.60 mm in the transconjunctival group and 4.40 ± 1.66 mm in the transnasal group (P = 0.435). A significant difference was found between preoperative and postoperative proptosis in both groups (P < 0.01). In the transconjunctival group, a higher surgical accuracy in the medial wall was found (P = 0.001). There was no significant difference in both groups between preoperative and postoperative BCVA and ocular motility grade. Complications showed no significant difference between two groups (P > 0.05). Conclusion Both transconjuntival and transnasal endoscopic orbital decompression were feasible, and could be utilized by surgeons. This study was registered with Chinese clinical trial registry (Trial registration number: ChiCTR-INR-17013268; date of access and registration: November 3, 2017).