Efficacy and complications of orbital fat decompression in Graves' orbitopathy: a systematic review and meta-analysis

Abstract

In Graves' orbitopathy, surgical decompression is often needed for functional and aesthetic reasons. This meta-analysis was performed to assess the efficacy and safety of fat removal orbital decompression (FROD) alone to treat exophthalmos in Graves' orbitopathy. A systematic search was conducted in PubMed/MEDLINE, Web of Science, and Cochrane Library for studies published before August 2018. Random-effects meta-analyses were applied; weighted means and weighted proportions with corresponding 95% confidence intervals (CI) were calculated. Study quality and quality of evidence for each individual outcome were analyzed. Of 1908 records initially identified, 13 observational studies were selected, representing 4820 orbits in 2514 patients. Weighted Hertel exophthalmometry was 23.10mm (95% CI 21.77-24.43mm) preoperative and 19.31mm (95% CI 17.81-20.81mm) postoperative. The weighted mean difference was 3.81mm (95% CI 3.41-4.21mm). Five studies reported an improvement of diplopia after surgery, occurring in 943 of 1172 patients (weighted proportion 0.50, 95% CI 0.15-0.85). Persistent new onset diplopia was reported in five studies, or 124 of 1277 patients (weighted proportion 0.15, 95% CI 0.03-0.27). No serious adverse events were reported. Results support the effectiveness and safety of FROD to treat mild-to-moderate exophthalmos in Graves' orbitopathy. Prospective and controlled trials are needed to improve the level of evidence.

Keywords: Graves’ orbitopathy; endocrine ophthalmopathy; fat removal; orbital decompression.