Endoscopic transnasal inferomedial wall decompression with preservation of the anterior orbital strut for proptosis in thyroid eye disease

To describe the surgical technique of endoscopic transnasal inferomedial wall decompression with preservation of the anterior orbital strut for the treatment of proptosis in thyroid eye disease (TED), and to evaluate its feasibility, efficacy, and safety. Thirty-eight patients (60 eyes) diagnosed with TED without dysthyroid optic neuropathy were reviewed in this study. All patients underwent endoscopic transnasal inferomedial wall decompression with preservation of the anterior orbital strut for proptosis reduction. Preoperative and postoperative Hertel exophthalmometry, diplopia scores, best-corrected visual acuity (BCVA), visual field (VF), peripapillary retinal nerve fiber layer (RNFL) thickness and radial peripapillary capillary (RPC) density were analyzed. Mean proptosis decreased from 21.15 ± 2.45 mm preoperatively to 17.24 ± 2.02 mm postoperatively ( P < 0.001), with an average decrease of 3.91 ± 1.84 mm. Among the 23 patients without preoperative diplopia, 2 (8.7%) developed new-onset diplopia, while none of the 15 patients with preoperative diplopia experienced postoperative worsening. There were significant improvements in VF ( P < 0.05) after the surgery. Postoperative BCVA improvement and RNFL thinning were found ( P < 0.05), whereas RPC density did not change significantly ( P > 0.05). No intraoperative cerebrospinal fluid leakage or optic nerve injury was observed. In this uncontrolled retrospective series, endoscopic transnasal inferomedial wall decompression with preservation of the anterior orbital strut achieved satisfactory proptosis reduction with a low rate of new-onset diplopia, and favorable short-term safety outcomes in selected patients with TED. Larger prospective studies with longer follow-up and objective assessments of ocular alignment and motility are warranted to further validate these findings.