title: Endonasal endoscopic orbital decompression in patients with Graves' ophthalmopathy.
abstract: OBJECTIVE
  To present the results of endonasal endoscopic orbital decompression in patients with Graves' ophthalmopathy.
  
  
  METHODS
  Endonasal endoscopic orbital decompression was performed in 32 orbits of 21 patients with Graves' ophthalmopathy. In 17 patients the surgery was performed because of active ophthalmopathy non-responsive to conservative treatment, and in 4 patients for esthetic reasons. Preoperative and postoperative examination included visual acuity, examination of the eyelids and cornea, ocular motility, cover testing, Hertel exophthalmometry, and applanation tonometry.
  
  
  RESULTS
  Visual acuity improved from preoperative 0.81+/-0.28 (mean +/- standard deviation) to postoperative 0.92+/-0.21 (p=0.0032, Student t-test). Retraction of upper and lower eyelids, as well as exposure keratitis, was reduced after operation (p<0.001). Mean proptosis reduction in all orbits was 4.6+/-1.7 mm (p<0.001). An average reduction of intraocular pressure was 3.4+/-3.0 mmHg (p<0.001). New-onset diplopia developed in 8 patients. Diplopia persisted in 9 out of 11 patients who had preoperative diplopia. Two patients experienced postoperative relief of diplopia. Ocular motility was subsequently corrected by eye muscle surgery in 13 eyes, whereas prisms were used in other 5 manifestly strabic eyes.
  
  
  CONCLUSIONS
  Endonasal endoscopic orbital decompression procedure improved visual acuity, decreased proptosis and intraocular pressure, and also had favorable cosmetic results in most patients. Post decompression diplopia and strabismus were successfully managed by either eye muscle surgery or application of prisms.
authors.affiliation: Department of Ophthalmology, Zagreb University Hospital Center, Kispaticeva 12, 10000 Zagreb, Croatia. nedastig@mef.hr
authors.forename: Neda
authors.initials: N
authors.lastname: Stiglmayer
authors.forename: Ranko
authors.initials: R
authors.lastname: Mladina
authors.forename: Martina
authors.initials: M
authors.lastname: Tomić
authors.forename: Miljenka
authors.initials: M
authors.lastname: Tojagić
authors.forename: Jelena
authors.initials: J
authors.lastname: Juri
authors.forename: Neda
authors.initials: N
authors.lastname: Bubas
authors.forename: Visnja
authors.initials: V
authors.lastname: Mrazovac
mesh_terms: D000328:Adult; D000368:Aged; D017523:Croatia; D019299:Decompression, Surgical / Q000379:methods*; D003941:Diagnostic Techniques, Ophthalmological; D004724:Endoscopy; D005094:Exophthalmos / Q000601:surgery*; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit / Q000601:surgery*; D016896:Treatment Outcome