PREDICTORS OF RESPONSE TO TRANSANTRAL ORBITAL DECOMPRESSION IN SEVEREGRAVES OPHTHALMOPATHY

Objective: To identify factors that may help predict the outcome after transantral orbital decompression in Graves' ophthalmopathy. Design: A retrospective study was conducted of 428 patients who had undergone an initial transantral orbital decompression for severe Graves' ophtha lmopathy at the Mayo Clinic between November 1969 and May 1989. Materi al and Methods: With use of logistic regression analysis, we assessed the preoperative characteristics, the early postoperative results, and the followup questionnaire data (obtained a median of 9.5 years posto peratively) from 304 female and 124 male patients with Graves' ophthal mopathy who had undergone transantral orbital decompression at a media n age of 53 years. Results: On multivariate stepwise regression analys is, young age, male sex, and long duration of eye symptoms were predic tors of severe initial proptosis (P<0.001). The only independent predi ctors of greater postoperative recession of proptosis were severity of initial proptosis and longer interval between operation and postopera tive examination (P<0.001). Patients with the most reduction of propto sis had the greatest improvement in visual acuity but more chance for postoperative development of continuous diplopia. Failure of prior cor ticosteroid or orbital radiation therapy did not affect the degree of recession of proptosis or improvement in visual acuity. On multivariat e analysis for predictors of long-term overall patient satisfaction, o nly young age of the patient was of borderline significance (P = 0.05) , and the Only significant predictor of satisfaction with the postoper ative eye appearance was an operation done primarily for cosmetic purp oses (P = 0.012). Conclusion: Although various factors may influence t he outcome of orbital decompression in patients with Graves' ophthalmo pathy, this study showed that the more pronounced the initial proptosi s, the greater the degree of recession postoperatively. A higher degre e of reduction of proptosis is associated with better visual acuity bu t also a greater likelihood of development of continuous diplopia.