STAGED OPERATION FOR GRAVES OPHTHALMOPATHY

A four-staged operation is currently the most effective treatment avai lable in the management of stable Graves' ophthalmopathy. This report describes the results of four-staged therapy in 51 patients with Grave s' ophthalmopathy. Stage I, orbital decompression: 58 orbits in 32 pat ients underwent orbital decompression, with an average retroplacement effect of 4.2 +/- 2.2 mm (mean +/- SD). This procedure is effective to restore vision and correct the proptosis due to Graves' ophthalmopath y. Careful intraoperative titration of the retroplacement effect durin g orbital decompression is very important to active successful results . Stage II, strabismus surgery: 24 patients underwent strabismus surge ry, including 11 with previous decompression surgery and six with prev ious simultaneous decompression and strabismus surgery. The overall su ccess rate was 87% and previous decompression or strabismus surgery ha d no influence on the final results. Stage III, fissure width adjustme nt: 28 patients (45 eyes) received fissure width adjustment. Various p rocedures were performed and we found Mullerectomy with levator muscle stripping to be the most useful procedure for fissure width adjustmen t. The average improvement of fissure height was 3.1 +/- 1.8 mm. The r ate of overall satisfactory results was 89%. There were five patients who received Staged IV cosmetic procedures with satisfactory results. Graves' ophthalmopathy is a chronic disease that needs thorough cooper ation between doctor and patient. Careful evaluation of clinical param eters and individualized surgical goals are the keys to success.