{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:25:05Z","timestamp":1783988705993,"version":"3.55.0"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T00:00:00Z","timestamp":1631664000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T00:00:00Z","timestamp":1631664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100008678","name":"Universit\u00e4t Leipzig","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008678","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Head Face Med"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Orbital decompression surgery is frequently the last therapeutic measure in the surgical treatment of endocrine orbitopathy (EO). Additional rehabilitative and corrective surgical treatments are often used to improve the resulting eyelid stigmata, such as an increased lid aperture and scleral show. The aim of the study was to evaluate the effect of adjunctive surgical procedures after orbital decompression surgery in patients with EO.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A total of 120 orbitae from 65 patients with EO from 2010 to 2020 at a tertiary care center in Germany were retrospectively evaluated. Ocular surface area (OSA) and vertical palpebral fissures were three-dimensionally analyzed at the following stages: presurgical decompression, postsurgical decompression, and post-adjunctive surgical procedures. For the analysis of vertical palpebral fissures, predefined vertical line distances were measured on the upper and lower lids in the central, medial, and lateral pupillary regions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The initial OSA was 2,98\u2009\u00b1\u20090.85\u2009cm<jats:sup>2<\/jats:sup>, and it decreased significantly after decompression surgery to 2.52\u2009\u00b1\u20090.62\u2009cm<jats:sup>2<\/jats:sup>. After adjunct surgical procedures, OSA further decreased to 2,31\u2009\u00b1\u20090,55\u2009cm<jats:sup>2<\/jats:sup>. Furthermore, a statistically significant reduction in all pupillary parameters was noted after each treatment step. More lid-lengthening procedures were performed on the lower lid than on the upper lid. Canthoplasty (<jats:italic>n<\/jats:italic>\u2009=\u200913) was the most frequently performed procedure during rehabilitation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Surgical decompression surgery improves OSA and leads to a significant reduction in lid aperture. Adjunctive surgical procedures, addressing the upper and lower lid, have a significant influence on the ongoing clinical course and contribute to a reduction in OSA.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13005-021-00290-2","type":"journal-article","created":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T05:03:01Z","timestamp":1631682181000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Eyes wide shut: necessity and effect of adjunctive procedures after decompression surgery in patients with endocrine orbitopathy"],"prefix":"10.1186","volume":"17","author":[{"given":"Matthias","family":"Krause","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Kamal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Halama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Hierl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ina","family":"Sterker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00fcdiger","family":"Zimmerer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Lethaus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3545-1341","authenticated-orcid":false,"given":"Alexander K.","family":"Bartella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,15]]},"reference":[{"key":"290_CR1","unstructured":"Bartalena L. Graves\u2019 Disease: Complications. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dungan K, Grossman A, Hershman JM, Hofland HJ, Kaltsas G, et al., editors. Endotext. South Dartmouth; 2000. PMID: 25905406. Bookshelf ID: NBK285551."},{"issue":"1","key":"290_CR2","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1159\/000443828","volume":"5","author":"L Bartalena","year":"2016","unstructured":"Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly GJ, Marcocci C, et al. European group on graves O: the 2016 European thyroid association\/European group on Graves\u2019 Orbitopathy guidelines for the Management of Graves\u2019 Orbitopathy. Eur Thyroid J. 2016;5(1):9\u201326. https:\/\/doi.org\/10.1159\/000443828.","journal-title":"Eur Thyroid J"},{"issue":"10","key":"290_CR3","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1089\/105072502761016476","volume":"12","author":"WM Wiersinga","year":"2002","unstructured":"Wiersinga WM, Bartalena L. Epidemiology and prevention of Graves\u2019 ophthalmopathy. Thyroid. 2002;12(10):855\u201360. https:\/\/doi.org\/10.1089\/105072502761016476.","journal-title":"Thyroid"},{"issue":"4","key":"290_CR4","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1016\/S0161-6420(86)33712-6","volume":"93","author":"N Shorr","year":"1986","unstructured":"Shorr N, Seiff SR. The four stages of surgical rehabilitation of the patient with dysthyroid ophthalmopathy. Ophthalmology. 1986;93(4):476\u201383. https:\/\/doi.org\/10.1016\/S0161-6420(86)33712-6.","journal-title":"Ophthalmology"},{"key":"290_CR5","doi-asserted-by":"publisher","first-page":"249125","DOI":"10.1155\/2015\/249125","volume":"2015","author":"J Barrio-Barrio","year":"2015","unstructured":"Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velazquez-Villoria A, Galofre JC. Graves\u2019 Ophthalmopathy: VISA versus EUGOGO classification, assessment, and management. 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Orbit. 2016;35(6):335\u20138. https:\/\/doi.org\/10.1080\/01676830.2016.1193546.","journal-title":"Orbit"}],"container-title":["Head &amp; Face Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13005-021-00290-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13005-021-00290-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13005-021-00290-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T05:03:20Z","timestamp":1631682200000},"score":1,"resource":{"primary":{"URL":"https:\/\/head-face-med.biomedcentral.com\/articles\/10.1186\/s13005-021-00290-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,15]]},"references-count":12,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["290"],"URL":"https:\/\/doi.org\/10.1186\/s13005-021-00290-2","relation":{},"ISSN":["1746-160X"],"issn-type":[{"value":"1746-160X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,15]]},"assertion":[{"value":"4 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Ethics Committee of Leipzig University (083\/20 ek). This report followed the Declaration of Helsinki on medical protocol and ethics. Written informed consent to participate was obtained by all patients.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors consent to publication. All patients provided written informed consent to publish personal data and use their images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"41"}}