Course of proptosis in patients with Graves' disease after endoscopic orbital decompression

Aim To evaluate the results of follow-up and postoperative course of propto sis in patients with Graves' disease who underwent combined transconjunctiv al and transnasal endoscopic orbital decompression. Methods: Charts of pati ents with Graves' disease who underwent orbital decompression using combine d transconjunctival and transnasal endoscopic technique were reviewed. The surgical technique involved preservation of the strut of bane between the l amina papyracea of the ethmoid and floor of the orbit of the maxilla, Data pertaining to patient demographics, previous treatments for orbit all manif estations of Graves' disease, and preoperative and postoperative otolaryngo logic and ophthalmologic examination findings were obtained. Postoperative course of reduction in proptosis was evaluated based on Hertel exophthalmom etry measurements obtained in four intervals: 1) 0 to 1 month, 2) 1 month t o 3 months, 3) 3 to 6 months, 4) 8 to 12 months. Results: Twenty-eight orbi tal decompressions were performed on 15 patients. All patients were unrespo nsive to corticosteroids and orbital irradiation. Ten orbits exhibited preo perative and postoperative visual acuity of 20/20. Vision improved in nine orbits and did not change in six orbits. Proptosis was :reduced in 25 orbit s, Postoperative course of reduction in proptosis varied within year 1, wit h the smallest proptosis measurements documented between 6 and 12 months. C onclusions: Combined transconjunctival and transnasal endoscopic orbital de compression with preservation of the strut resulted in regression of propto sis, marked reduction in postoperative diplopia development, and improvemen t of visual acuity in patients with Graves' disease. Course of reduction in proptosis varied within postoperative 1 year, with the biggest reduction o ccurring between 6 and 12 months.