Intraocular pressure changes after treatment for Graves' orbitopathy

Objective: To evaluate the change in intraocular pressure (IOP) in subjects with Graves' orbitopathy (GO) after orbital decompression, strabismus surg ery, and orbital radiation. Design: Retrospective case review. Methods: The charts of 172 consecutive subjects from the Neuro-ophthalmolog y Service at Wills Eye Hospital (Philadelphia, PA) with GO who underwent ei ther orbital decompression, strabismus surgery, or orbital radiation betwee n 1994 and 1999 were analyzed. Subject age, gender, diagnosis of glaucoma i n either eye, use of systemic steroids or topical glaucoma medications, pro cedure performed, and the preoperative and postoperative IOP tin primary po sition and upgaze) were evaluated. Results: Of 116 eyes that underwent orbital decompression, the mean preoper ative IOP was 21.6 +/- 4.6 mmHg (standard deviation) in primary position an d 27.9 +/- 6.8 mmHg in upgaze, The postoperative IOP was 17.5 mmHg +/- 3.0 mmHg in primary position and 20.1 +/- 4.7 mmHg in upgaze, a decrease in IOP of 18.9% in primary position and 27.9% in upgaze (P < 0.001). Subjects tak ing glaucoma medication or who had IOP greater than 21 mmHg demonstrated a significantly (P < 0.001) greater reduction in IOP postoperatively, The mea n preoperative IOP in the 32 subjects who had strabismus surgery was 18.5 /- 2.8 mmHg (primary position), and 24.7 +/- 4.3 mmHg (upgaze), Postoperati ve IOP was 16.1 mmHg (primary position) and 16.9 mmHg (upgaze), a decrease of 2.4 mmHg (13.3%, P < 0.01 in primary position) and 7.8 mmHg (31.2%, P < 0.01 in upgaze). There was no statistically significant reduction in IOP af ter orbital radiation. Conclusions: In the selected subgroup of subjects with GO who required inte rvention, orbital decompression and strabismus surgery resulted in a signif icant reduction in IOP in the early postoperative period, especially in sub jects with preoperative IOP greater than 21 mmHg, Ophthalmology 2001;108:14 5-150 (C) 2001 by the American Academy of Ophthalmology.