ArticleClinical ophthalmology (Auckland, N.Z.)2026
Clinical Outcomes of Orbital Fat Decompression in Pediatric Thyroid Eye Disease: A Two-Center Retrospective Study.
Article in Clinical ophthalmology (Auckland, N.Z.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: To evaluate the clinical outcomes and safety of orbital fat decompression in pediatric patients with thyroid eye disease (TED). Patients and Methods: This retrospective two-center study included pediatric patients (≤17 years; achieved age range 12-17 years) with inactive, non-sight-threatening TED (Clinical Activity Score 0-1) who underwent orbital fat decompression between June 2017 and February 2025 at two centers in Japan. Patients with follow-up <3 months, prior orbital decompression, or additional eyelid surgery within 3 months were excluded. Outcomes assessed included Hertel exophthalmometry, lower scleral show, diplopia, and postoperative complications. Results: Twenty patients (39 eyes) were included. Mean proptosis was significantly reduced after surgery (p < 0.001), with a combined mean reduction of 2.36 mm (95% CI 1.97-2.75 mm; right eye 2.30 mm, left eye 2.39 mm). Lower scleral show improved in 84.2% of patients, with complete resolution in 63.2%; outcomes were similar after excluding three patients who underwent concomitant lower eyelid fat grafting. Subjectively perceived diplopia was documented in 5 patients (25%) on postoperative day 1 and persisted at 1 month in 2 patients (10%); all cases resolved by final follow-up with no persistent or de novo symptomatic diplopia. Mydriasis occurred in 4 patients (20%), resolving completely in 3, with mild asymptomatic residual pupillary asymmetry in 1 patient at final follow-up. No vision-threatening complications, visual acuity loss, infections, or wound-related complications occurred. Conclusion: Orbital fat decompression via a sutureless transconjunctival approach achieved clinically meaningful and statistically significant improvement in proptosis and lower eyelid position in pediatric TED, with generally self-limiting complications and no vision-threatening adverse events, although mild asymptomatic pupillary asymmetry persisted in one patient at final follow-up. These findings support orbital fat decompression as a viable surgical option in pediatric patients, although they should be confirmed in larger, prospective, multicenter studies with longer follow-up.
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