GRAVES OPHTHALMOPATHY - RESULTS OF TRANSANTRAL ORBITAL DECOMPRESSION PERFORMED PRIMARILY FOR COSMETIC INDICATIONS

Purpose: Transantral orbital decompression is effective treatment for excessive proptosis and optic neuropathy due to Graves ophthalmopathy. In these sight-threatening circumstances, patients willingly accept t he side effects of orbital decompression. When transantral orbital dec ompression is performed for cosmetic indications, patients' acceptance of side effects may be different. This study reports detailed results of transantral decompression for 34 patients in whom the indications were primarily cosmetic. Methods: The medical records of 34 patients w ith Graves ophthalmopathy who had transantral orbital decompression pr imarily for cosmetic indications were reviewed. Preoperative and posto perative physical features of the eyes were compared. Long-term assess ment was formulated from follow-up examination and a follow-up questio nnaire. Results: The most notable improvement was in the reduction of proptosis (mean decrease, 5.2 mm). The frequency of asymmetry of propt osis, however, did not improve. Asymmetry was more than 1 mm in 44% of patients preoperatively and in 54% postoperatively. Although the palp ebral fissure was decreased by an average of 2.7 mm, upper lid retract ion became worse in 12(43%) of 28 eyes. Of 15 patients who had no dipl opia preoperatively, continuous diplopia developed postoperatively in 73%. The patients underwent a total of 37 eye muscle operations and 31 eyelid operations after decompression. Of 29 patients who responded t o a long-term follow-up questionnaire, 69% were satisfied with the app earance of the eyes and 31% found it acceptable. No patient was dissat isfied. Symptomatic diplopia was present in 6.9% of patients at the ti me of the follow-up questionnaire. Conclusion: Transantral orbital dec ompression performed for cosmetic indications in Graves ophthalmopathy may need to be followed by eye muscle and lid operations. These proce dures result in a high degree of patient satisfaction. However, a smal l percentage of patients experience persistent diplopia, despite multi ple eye muscle procedures.