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. 2018 Aug 18;11(8):1363-1370.
doi: 10.18240/ijo.2018.08.18. eCollection 2018.

Orbital decompression surgery for the treatment of Graves' ophthalmopathy: comparison of different techniques and long-term results

Mehmet Ozgur Cubuk  1 , Onur Konuk  2 , Mehmet Unal  3
Affiliations

Orbital decompression surgery for the treatment of Graves' ophthalmopathy: comparison of different techniques and long-term results

Mehmet Ozgur Cubuk et al. Int J Ophthalmol. .

Abstract

Aim: To evaluate the long-term results of different orbital decompression techniques performed in patients with Graves' ophthalmopathy (GO).

Methods: Totally 170 cases with GO underwent orbital decompression between 1994 and 2014. Patients were divided into 4 groups as medial-inferior, medial-lateral (balanced), medial-lateral-inferior, and lateral only according to the applied surgical technique. Surgical indications, regression degrees on Hertel exophthalmometer, new-onset diplopia in the primary gaze and new-onset gaze-evoked diplopia after surgery and visual acuity in cases with dysthyroid optic neuropathy (DON) were compared between different surgical techniques.

Results: The study included 248 eyes of 149 patients. The mean age for surgery was 42.3±13.2y. DON was the surgical indication in 36.6% of cases, and three-wall decompression was the most preferred technique in these cases. All types of surgery significantly decrease the Hertel values (P<0.005). Balanced medial-lateral, and only lateral wall decompression caused the lowest rate of postoperative new-onset diplopia in primary gaze. The improvement of visual acuity in patients with DON did not significantly differ between the groups (P=0.181).

Conclusion: The study show that orbital decompression surgery has safe and effective long term results for functional and cosmetic rehabilitation of GO. It significantly reduces Hertel measurements in disfiguring proptosis and improves visual functions especially in DON cases.

Keywords: Graves' ophthalmopathy; dysthyroid optic neuropathy; orbital decompression.

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Figures

Figure 1
Figure 1. Patient with GO
Right eye VA=10/10, left eye VA=light perception (+) (Snellen chart), left unilateral exposure keratopathy with DON. Left eye VA=6/10 (Snellen chart) after medial-inferior-lateral decompression surgery.
Figure 2
Figure 2. Patient with GO
Right eye VA= finger counting, left eye VA=light perception (-), bilateral DON (+). Right eye VA=6/10 (Snellen chart), left eye VA=finger counting after bilateral medial-inferior-lateral decompression surgery.
See this image and copyright information in PMC

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