title: Graded orbital decompression based on severity of proptosis.
abstract: OBJECTIVE
  To study the results of orbital decompression based on the severity of preoperative proptosis.
  
  
  METHODS
  A retrospective noncomparative interventional case series.
  
  
  METHODS
  Thirty-nine orbits in 23 patients with thyroid-related orbitopathy at a university-based referral center.
  
  
  METHODS
  Graded orbital decompression was performed in all patients based on the severity of preoperative exophthalmometry.
  
  
  METHODS
  Exophthalmometry, visual acuity, margin-to-reflex distance, prism cover testing, and intraocular pressure.
  
  
  RESULTS
  Mean proptosis reduction in all orbits was 6.4 +/- 2.7 mm (P < 0.01). In group 1 (preoperative exophthalmometry <22 mm), proptosis decreased with a mean of 4.8 +/- 1.3 mm (P < 0.01); mean proptosis reduction was 6.0 +/- 2.3 mm (P < 0.01) and 8.9 +/- 3.4 mm (P < 0.01) in group 2 (exophthalmometry between 22-25 mm) and group 3 (exophthalmometry >25 mm), respectively. In four of five eyes with compressive optic neuropathy there was an improvement of best-corrected visual acuity of 2 lines or more. Margin-to-reflex distance of the upper and lower lids and intraocular pressure were reduced in all groups. New-onset diplopia developed in two patients (8.7%); 13 of 15 patients (86.7%) who had diplopia preoperatively had persistent diplopia postoperatively. Two patients (13.3%) had relief of diplopia postoperatively.
  
  
  CONCLUSIONS
  Graded orbital decompression based on the severity of preoperative exophthalmometry is useful to determine the type and amount of orbital surgery to be performed.
authors.affiliation: Shiley Eye Center, UCSD Department of Ophthalmology, 9500 Gilman Drive, La Jolla, CA 92093-0946, USA.
authors.forename: Don O
authors.initials: DO
authors.lastname: Kikkawa
authors.forename: Kanograt
authors.initials: K
authors.lastname: Pornpanich
authors.forename: Romeo C
authors.initials: RC
authors.lastname: Cruz
authors.forename: Leah
authors.initials: L
authors.lastname: Levi
authors.forename: David B
authors.initials: DB
authors.lastname: Granet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods*; D003941:Diagnostic Techniques, Ophthalmological; D005094:Exophthalmos / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014792:Visual Acuity