Effects of orbital decompression on duction, cyclotorsion and diplopia
Reviewed by Jonathan Chan

This is a retrospective review of 156 patients (281 eyes / orbits) with Graves Orbitopathy (GO) who had orbital decompression (OD) between 2016 and 2020 from Amsterdam, Netherlands. Data analysis of type of OD, eye position, duction, cyclotorsion and level of diplopia according to the Gorman score were recorded. Proptosis decreased from 23.8–20.9mm (mean). Horizontal and vertical duction range decreased after surgery but not clinically significant (<5 degrees). Horizontal deviation changed towards esotropic deviation, whereas vertical deviation remained stable. Cyclotorsion changed towards incyclotorsion in both primary and downgaze positions after surgery. For 18 patients (22%) diplopia improved, whereas 12 patients (11%) developed new onset constant diplopia after surgery. Preoperative restriction on elevation of <19 degrees is an excellent predictive value (sensitivity 88%, specificity 41.7%) for new onset constant diplopia. The authors concluded that the incidence of new onset diplopia was 11%, and 22% had partial or complete improvement of diplopia. Presence of preoperative restrictive elevation of <19 degrees and incyclotorsion may worsen after OD.

Effects of orbital decompression on duction, cyclotorsion and diplopia.
Jellema HM, Althaus M, Merckel-Timmer E, et al.
BRITISH JOURNAL OF OPHTHALMLOGY
2024;108:1075–80.