Wr. Nunery et al., THE RISK OF DIPLOPIA FOLLOWING ORBITAL FLOOR AND MEDIAL WALL DECOMPRESSION IN SUBTYPES OF OPHTHALMIC GRAVES-DISEASE, Ophthalmic plastic and reconstructive surgery, 13(3), 1997, pp. 153-160
We preoperatively divided 58 ophthalmic Graves' disease patients into
types I and II categories before two-wall orbital decompression. Type
I classification was given to patients who had no diplopia and essenti
ally normal versions. Type IT classification was assigned to patients
with restrictive motility loss and diplopia within 20 degrees of the p
rimary position. Ocular motility was assessed before and after two-wal
l orbital decompression. Only one of 25 type I patients (4%) experienc
ed diplopia after orbital decompression, while seven of 14 (50%) (p =
0.001) type II patients without preoperative primary-position diplopia
had primary diplopia postoperatively. Of 12 type II patients who had
preoperative primary-position diplopia, esotropia increased by an aver
age of 12.4 diopters postoperatively. Vertical deviation increased an
average of 13.4 diopters for 10 patients who underwent unilateral two-
wall decompression. The likelihood of new or worsening diplopia in all
type II patients following decompression was 22 of 36 (61%). We concl
ude that adverse motility change following two-wall orbital decompress
ion is rare in type I disease patients, but it occurs 61% of the time
in type II disease patients. Predicting preoperatively which patients
are likely to develop adverse motility change and diplopia may help cl
arify indications and risks of orbital decompression surgery in patien
ts with ophthalmic Graves' disease.