title: "Balanced" orbital decompression for severe Graves' orbitopathy: technique with treatment algorithm.
abstract: BACKGROUND
  Graves' orbitopathy can produce proptosis, compressive optic neuropathy, and extraocular motility abnormalities; symptoms result from an increase in orbital volume due to expansion of intraorbital fat, with or without extraocular muscle involvement.
  
  
  METHODS
  We conducted a chart review of patients who underwent orbital decompression to treat Graves' orbitopathy. Twenty-two orbits (13 patients) underwent orbital bone decompression, of which 17 orbits (9 patients) underwent the combined medial and lateral "balanced" decompression.
  
  
  RESULTS
  All patients had significant improvement with an average decrease in proptosis of 5.9 mm in the balanced decompression group. Restoration of normal optic nerve function was achieved in all patients with compressive optic neuropathy. Diplopia was noted in 4 patients (30.7%) preoperatively. Two patients had new postoperative diplopia (15.35%).
  
  
  CONCLUSIONS
  In our experience, "balanced" decompression results in a reduction of proptosis and improved optic nerve function and has a low incidence of complications.
authors.affiliation: Departments of Otolaryngology-Head and Neck Surgery and Ophthalmology, New York Presbyterian Hospital-Columbia Campus, USA. ask9001@mail.med.cornell.edu
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Kacker
authors.forename: Michael
authors.initials: M
authors.lastname: Kazim
authors.forename: Mark
authors.initials: M
authors.lastname: Murphy
authors.forename: Stephen
authors.initials: S
authors.lastname: Trokel
authors.forename: Lanny G
authors.initials: LG
authors.lastname: Close
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D019299:Decompression, Surgical / Q000379:methods*; D004172:Diplopia / Q000453:epidemiology / Q000209:etiology; D004724:Endoscopy / Q000379:methods; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011241:Prednisone / Q000627:therapeutic use; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014786:Vision Disorders / Q000188:drug therapy / Q000209:etiology; D014794:Visual Fields / Q000187:drug effects
chemical_list: D000893:Anti-Inflammatory Agents; D011241:Prednisone