Graves’ orbitopathy is the most frequent extrathyroidal manifestation of Graves’ disease, affecting approximately 25-50% of patients. It leads to inflammation and swelling of orbital soft tissues. The treatment is mostly conservative. Surgical orbital decompression is indicated in severe cases with disfiguring exophthalmos or an acute steroid-refractive threat to vision, facilitating visual and cosmetic recovery. An important aspect in the quality of care is the avoidance of postoperative diplopia.
To report experiences and results from 100 cases of orbital decompression surgery performed on 62 patients at a multidisciplinary orbit center. Patients with signs of apical crowding were treated by pterional decompression. Patients without signs of apical crowding were treated either by deep lateral wall resection or pterional decompression.
A retrospective data analysis was carried out.
The mean reduction in exophthalmos was 2.9 mm. Visual acuity improved by a mean of 2.2 lines in eyes with sight-threatening disease. In moderate to severe disease, visual acuity remained stable. The complication rate was 4%. New postoperative diplopia occurred after two interventions and one patient experienced a deterioration in visual acuity from 0.8 to 0.1. In nine cases, surgery led to a complete regression of previously reported double vision.
Visual acuity gain, reduction of exophthalmos and complications in this collective are comparable to previously published results. The results of this study confirm the role of orbital decompression in the treatment of sight-threatening and severely disfiguring endocrine orbitopathy.