Treatment of proptosis with fat removal orbital decompression in Graves' ophthalmopathy

Purpose. Retrospective evaluation of 41 proptosis reduction procedures usin g fat removal orbital decompression (FROD) according to a modified Olivari' s technique. Methods. Trans-septal excision of extraconal and intraconal fat was done un der the microscope through the upper and lower eyelid blepharoplasty approa ch. Proptosis was measured with a Hertel exophthalmometer. Results. Mean excision of 7.31 + 1.9 ml (range 3.25 - 12 ml) of orbital fat reduced proptosis on average by 4.7 + 2.4 m m (range 1-11 mm). Side effect s were few, limited only to ocular motility disturbances. There was no sign ificant effect on visual fileds. A postoperative drop in IOP was noted in p atients with preoperative IOP above 21 mmHg. Efficient palpebral lengthenin g can be achieved with combined section of the levator aponeurosis horns in the upper eyelid, and/or auricular cartilage graft in the lower eyelid. Conclusions. FROD reduces proptosis in Grave's ophthalmopathy.