Effects of bilateral balanced orbital decompression on orbital, retinal, and choroidal vascular parameters in thyroid-associated orbitopathy

Abstract To evaluate vascular changes following balanced orbital decompression (BOD) in thyroid-associated orbitopathy (TAO). This prospective study included 30 orbits of 15 patients with inactive TAO undergoing BOD. Clinical, orbital vascular, and retinal/choroidal microvascular parameters were assessed preoperatively and at postoperative months 1, 3, and 6 using patient-clustered generalized estimating equation models. Proptosis decreased by 3.93 mm at month 6 (95% CI, − 4.62 to − 3.25; p < 0.001), while BCVA remained stable. OA-PSV increased by 7.77 cm/s at month 3 (95% CI, 0.81 to 14.72; p = 0.029), and SOV diameter decreased by 0.261 mm at month 6 (95% CI, − 0.431 to − 0.091; p = 0.003). From month 1 to month 6, central SCP, DCP, and CC vessel densities increased by 1.54, 1.42, and 2.23%, respectively ( p = 0.006, p = 0.014, and p < 0.001), whereas superior SCP and DCP densities decreased from baseline to month 6 ( p = 0.033 and p = 0.032). FAZ area decreased at months 3 and 6 ( p < 0.001 and p = 0.021). SFCT decreased at month 3 ( p = 0.002), and CVI decreased by 0.61 at month 6 (95% CI, − 1.16 to − 0.05; p = 0.031). BOD was associated with temporally and regionally heterogeneous orbital and ocular vascular changes. The study was retrospectively registered at ClinicalTrials.gov (Identifier: NCT07393230).