Endoscopic orbital decompression for Graves' ophthalmopathy.
BACKGROUND
In patients with Graves' ophthalmopathy, orbital decompression surgery is indicated for compressive optic neuropathy, severe corneal exposure, or for cosmetic deformity due to proptosis. Traditionally this has been performed through a transantral approach, but the associated complication rate is high. More recently, endoscopic orbital decompression has been performed successfully with significantly fewer postoperative complications.


OBJECTIVE
To report our experience of endoscopic orbital decompression in patients with severe Graves' ophthalmopathy.


METHODS
Three patients (five eyes) underwent endoscopic orbital decompression for Graves' ophthalmopathy at Soroka Medical Center between the years 2000 and 2002. The indications for surgery were compressive optic neuropathy in three eyes, severe corneal exposure in one eye, and severe proptosis not cosmetically acceptable for the patient in one case. An intranasal endoscopic approach with the removal of the medial orbital wall and medial part of the floor was performed.


RESULTS
In all five eyes an average reduction of 5 mm in proptosis was achieved. Soon after surgery, visual acuity improved in the three cases with compressive optic neuropathy, and exposure keratopathy and cosmetic appearance also improved. The diplopia remained unchanged. No complications were observed postoperatively.


CONCLUSIONS
Endoscopic orbital decompression with removal of the medial orbital wall and medial part of the floor in the five reported eyes was an effective and safe procedure for treatment of severe Graves' ophthalmopathy. A close collaboration between ophthalmologists and otorhinolaryngologists skilled in endoscopic sinus surgery is crucial for the correct management of these patients.
Levy
Jaime
J
Departments of Ophthalmology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. ljaime@bgu.ac.il
Puterman
Moshe
M
Lifshitz
Tova
T
Marcus
Mira
M
Segal
Avichai
A
Monos
Tova
T
D000328:Adult; D003316:Corneal Diseases / Q000209:etiology / Q000601:surgery; D019299:Decompression, Surgical; D004724:Endoscopy; D005094:Exophthalmos / Q000209:etiology / Q000601:surgery; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000209:etiology / Q000601:surgery; D009915:Orbit / Q000601:surgery*