title: Balanced orbital decompression combined with fat removal in Graves ophthalmopathy: do we really need to remove the third wall?
abstract: OBJECTIVE
  To compare the reduction of proptosis and the incidence of new-onset diplopia after 3-wall (medial, lateral, and inferior) orbital decompression versus balanced medial and lateral wall decompression combined with orbital fat excision in patients with Graves ophthalmopathy.
  
  
  METHODS
  Three-wall orbital decompression including medial, inferior, and lateral walls was performed in 13 eyes of 7 patients (group 1), and balanced medial and lateral wall decompression combined with fat removal was performed in 18 eyes of 11 patients (group 2). A transnasal endoscopic approach was used for medial wall removal. A lateral canthotomy incision combined with a short upper eyelid incision was used for extended lateral wall removal, and this was combined with an inferior conjunctival fornix incision when floor decompression was performed.
  
  
  RESULTS
  The mean reduction of proptosis was 6.9+/-1.6 mm and 6.5+/-1.3 mm in the first and second groups, respectively; the difference was not statistically significant (P=0.37). After 3-wall decompression, 57.1% of the patients had permanent new-onset diplopia (group 1), whereas none of the patients had permanent postoperative diplopia after balanced medial and lateral wall decompression combined with fat removal (group 2). The difference in permanent new-onset postoperative diplopia between two groups was statistically significant (P<0.001).
  
  
  CONCLUSIONS
  Balanced medial and lateral wall decompression combined with orbital fat removal provides an effective reduction in proptosis and reduces the incidence of postoperative permanent diplopia when compared with 3-wall decompression. This technique may eliminate the need for orbital floor excision.
authors.affiliation: Department of Ophthalmology, Gazi University Medical School, Ankara, Turkey. eunal@superonline.com
authors.forename: Mehmet
authors.initials: M
authors.lastname: Unal
authors.forename: Fikret
authors.initials: F
authors.lastname: Leri
authors.forename: Onur
authors.initials: O
authors.lastname: Konuk
authors.forename: Berati
authors.initials: B
authors.lastname: Hasanreisoğlu
mesh_terms: D000273:Adipose Tissue / Q000601:surgery*; D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D004172:Diplopia / Q000209:etiology / Q000503:physiopathology; D005094:Exophthalmos / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009915:Orbit / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed