Endoscopic orbital decompression for Graves' ophthalmopathy

In patients with Graves' ophthalmopathy, orbital decompression surgery is indicated for compressive optic neuropathy, severe corneal exposure, or for cosmetic deformity due to proptosis. Traditionally this has been performed through a transantral approach, but the associated complication rate i...

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Bibliographic Details
Published in:The Israel Medical Association journal 2004-11, Vol.6 (11), p.673-676
Main Authors: Levy, Jaime, Puterman, Moshe, Lifshitz, Tova, Marcus, Mira, Segal, Avichai, Monos, Tova
Format: Article
Language:English
Subjects:
Adult
Corneal Diseases - etiology
Corneal Diseases - surgery
Decompression, Surgical
Endoscopy
Exophthalmos - etiology
Exophthalmos - surgery
Female
Graves Disease - surgery
Humans
Male
Middle Aged
Optic Nerve Diseases - etiology
Optic Nerve Diseases - surgery
Orbit - surgery
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Summary:In patients with Graves' ophthalmopathy, orbital decompression surgery is indicated for compressive optic neuropathy, severe corneal exposure, or for cosmetic deformity due to proptosis. Traditionally this has been performed through a transantral approach, but the associated complication rate is high. More recently, endoscopic orbital decompression has been performed successfully with significantly fewer postoperative complications. To report our experience of endoscopic orbital decompression in patients with severe Graves' ophthalmopathy. Three patients (five eyes) underwent endoscopic orbital decompression for Graves' ophthalmopathy at Soroka Medical Center between the years 2000 and 2002. The indications for surgery were compressive optic neuropathy in three eyes, severe corneal exposure in one eye, and severe proptosis not cosmetically acceptable for the patient in one case. An intranasal endoscopic approach with the removal of the medial orbital wall and medial part of the floor was performed. In all five eyes an average reduction of 5 mm in proptosis was achieved. Soon after surgery, visual acuity improved in the three cases with compressive optic neuropathy, and exposure keratopathy and cosmetic appearance also improved. The diplopia remained unchanged. No complications were observed postoperatively. Endoscopic orbital decompression with removal of the medial orbital wall and medial part of the floor in the five reported eyes was an effective and safe procedure for treatment of severe Graves' ophthalmopathy. A close collaboration between ophthalmologists and otorhinolaryngologists skilled in endoscopic sinus surgery is crucial for the correct management of these patients.
ISSN:1565-1088