BALANCED ORBITAL DECOMPRESSION FOR GRAVES OPHTHALMOPATHY

Objective/Hypothesis: Surgical management of Graves' ophthalmopathy is an alternative to medical therapy with corticosteroids or external be am radiotherapy. Orbital decompression has commonly been performed via a transantral approach to the medial orbital wall and floor. Although an endoscopic approach to these walls has been described, a balanced approach (incorporating a lateral decompression by an ophthalmology te am) is desirable. Study Design: Retrospective review. Methods: Endosco pic medial decompression and extended lateral decompression were accom plished in 18 orbits (11 patients); inferior decompression was perform ed in 11 of these. Five additional procedures were performed. Results: Exophthalmos improved by a mean of 4.6 mm. All patients who underwent decompression for vision loss had improved vision after surgery. Expo sure keratitis improved in six of six orbits. Two of five patients und ergoing orbital decompression for vision loss developed postoperative diplopia, which was successfully treated with strabismus surgery or pr ism glasses. There were no other significant complications. Conclusion s: The endoscopic approach to the medial orbital wall is an important component of balanced orbital decompression for patients with Graves' ophthalmopathy. Balancing the decompression and preserving the medial orbital strut between the ethmoid cavity and the orbital floor may min imize the risk of diplopia.