Balanced orbital decompression for Graves' ophthalmopathy.
OBJECTIVE
Surgical management of Graves' ophthalmopathy is an alternative to medical therapy with corticosteroids or external beam 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 team) is desirable.


METHODS
Retrospective review.


METHODS
Endoscopic medial decompression and extended lateral decompression were accomplished in 18 orbits (11 patients); inferior decompression was performed 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. Exposure keratitis improved in six of six orbits. Two of five patients undergoing orbital decompression for vision loss developed postoperative diplopia, which was successfully treated with strabismus surgery or prism glasses. There were no other significant complications.


CONCLUSIONS
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 minimize the risk of diplopia.
Shepard
K G
KG
Division of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, California 94305-5328, USA.
Levin
P S
PS
Terris
D J
DJ
D000328:Adult; D000368:Aged; D004172:Diplopia / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods; D005005:Ethmoid Sinus / Q000601:surgery; D005094:Exophthalmos / Q000601:surgery; D005139:Eyeglasses; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D007634:Keratitis / Q000517:prevention & control; D008297:Male; D008443:Maxillary Sinus / Q000601:surgery; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D012189:Retrospective Studies; D013285:Strabismus / Q000601:surgery; D014786:Vision Disorders / Q000601:surgery; D014785:Vision, Ocular / Q000502:physiology