PREVALENCE AND MANAGEMENT OF ELEVATED INTRAOCULAR-PRESSURE IN PATIENTS WITH GRAVES ORBITOPATHY

Aims-To investigate the prevalence and to discuss the necessity of tre ating elevated intraocular pressures (IOP) in patients with Graves' or bitopathy (GO). In addition, to study the effects of orbital decompres sion and extraocular muscle surgery on IOP. Methods-The records of con secutive patients with GO referred in a 5 year period were studied and those selected, in which glaucoma medication had been prescribed, or a diagnosis of primary open angle glaucoma (POAG) or of ocular hyperte nsion (greater than or equal to 22 nun Hg) (OH) had been made. The nec essity of treating these patients with glaucoma medication was questio ned and the effects of corticosteroids, orbital decompression, and ext raocular muscle surgery on the IOP were evaluated. Results-Of 482 pati ents with GO, 23 (4.8%) met the inclusion criteria. Four patients (0.8 %) had POAG, four had elevated IOPs and visual field defects consisten t with dysthyroid optic neuropathy, and 15 (3.1%) had only elevated IO Ps. Five patients with OH showed a permanent drop of IOP after orbital decompression, two had a marked decrease of their IOP after recession of the inferior rectus muscle. Conclusions-POAG has the same prevalen ce in the general Dutch population as in the GO subgroup. The combinat ion of elevated IOPs and visual field defects in GO patients may be at tributed to other mechanisms than obstructed aqueous outflow in the tr abecular meshwork and should be treated accordingly. Orbital decompres sion and extraocular muscle surgery may lower the IOP in patients with GO.