ORBITAL DECOMPRESSION IN GRAVES-DISEASE

Objective: The authors' experience with surgical decompression of the orbits in patients with Graves' orbitopathy is reviewed. Design: One h undred twenty-six consecutive primary orbital decompressions were retr ospectively studied. Setting: Tertiary care university hospitals. Pati ents: All patients were referred by ophthalmologists for surgical deco mpression after failure of a trial of oral steroid therapy, and many h ad had orbital irradiation. Intervention: Antral-ethmoidal or transcon junctival surgical decompression was accomplished in all. Main Outcome s: Measurements of visual acuity, ocular motility, and proptosis were accomplished preoperatively and a minimum of 3 months postoperatively. Surgical complications were tallied. Results: Mean reduction of propt osis by antral-ethmoidal decompression was 5.3 mm, and 3.6 mm by the t ransconjunctival appproach. Visual acuity improved in 34 orbits, was u nchanged in 98 orbits, and decreased in one orbit. In a subgroup of 30 patients in whom ocular motility was quantified by prism cover test p reoperatively, motility was unchanged or improved in 21 and was decrea sed in nine. Complications were infrequent. Conclusion: The antral-eth moidal and transconjunctival approaches to orbital decompression are s afe and effective.