THE TRIPLE TECHNIQUE FOR TREATING STABLE GRAVES OPHTHALMOPATHY

Graves' ophthalmopathy may range from mild eyelid retraction to a deva stating process that involves the entire orbit and culminates in gross ocular congestion, massive proptosis, and even blindness. Whether the ophthalmopathy is mild or severe, patients are managed on an individu al basis according to the predominant clinical findings, which may inc lude congestion, myopathy, lid retraction, proptosis, and optic neurop athy, The process usually becomes quiescent after 6 months to 3 years; however, the changes caused by fibrosis (lid retraction and ocular mu scle enlargement) are permanent. The cornerstone of surgical treatment fur severe cases is bony orbital decompression; however, in our exper ience, mild to moderate Gr aves' ophthalmopathy is better treated by c ombining eyelid surgery and orbital lipectomy. Our approach consists o f a conservative orbital lipectomy, the lengthening of the levator-Mul ler complex by means of marginal myotomies, and a limited lateral tars al apposition. These three different surgical steps, which have been d escribed previously as isolated procedures, are undertaken on both eve s at the same time and modulated according to the deformity of the pat ient. The operation can be performed under local anesthesia with sedat ion, thus allowing intraoperative monitoring of the correction. the pa tient can be discharged after a few hours. The results in 32 operated eyes of 16 patients have been a marked aesthetic and functional improv ement, with no complications after 6 to 18 months of follow-up. The re lative simplicity and very low morbidity of this procedure, as well as its reliability, make it ideal in patients with mild to moderate aest hetic and functional impairment who are looking for a substantial impr ovement but. are unwilling to undergo a relatively major procedure suc h as a transosseous decompression, which, in our opinion, is the opera tion of choice only when the patient presents with optic neuropathy or major proptosis.