The influence of previous orbital irradiation on the outcome of rehabilitative decompression surgery in graves orbitopathy.
OBJECTIVE
To investigate whether orbital irradiation influences the outcome of decompression surgery in Graves orbitopathy.


METHODS
Retrospective, comparative case series.


METHODS
The medical records of all the patients with Graves orbitopathy treated with a three-wall orbital decompression through a coronal approach at our institution between January 1, 1990 and December 31, 2000 were reviewed. Only patients who underwent bilateral surgery for aesthetic rehabilitation, without preoperative diplopia, and who, in the active phase of the disease, had received orbital radiotherapy alone (20 Grays (Gy) in 10 daily fractions of two Gy over a period of two weeks; group R), systemic glucocorticoids alone (daily administration for more than three months independently from the dosage; group G), or both radiotherapy and glucocorticoids (group RG) were selected. Groups were compared for demographics, smoking habits, preoperative characteristics, and surgical outcome (mean reduction of exophthalmos, reduction of lid retraction, persistence of periorbital swelling requiring cosmetic eyelid surgery, onset of diplopia within 20 degrees of the central position of gaze, and variations in the peripheral field of diplopia).


RESULTS
Sixty-one of 376 patients were selected for this study. There were no differences between group R (n=29), group G (n=15), and group RG (n=17) with respect to demographics or predecompression characteristics, whereas the number of smokers was significantly greater in group RG (P=.019). We could not find differences in surgical outcome by comparing the three groups.


CONCLUSIONS
The total radiation dose, fraction size, and irradiated volume commonly used to treat active Graves orbitopathy do not adversely interfere with the outcome of rehabilitative decompression surgery.
Baldeschi
Lelio
L
Orbital Center, Department of Ophthalmology, University of Amsterdam, Amsterdam, The Netherlands. l.baldeschi@amc.uva.nl
MacAndie
Kerr
K
Koetsier
Eva
E
Blank
Leo E C M
LE
Wiersinga
Wilmar M
WM
D000328:Adult; D003131:Combined Modality Therapy; D019299:Decompression, Surgical / Q000534:rehabilitation*; D019583:Dose Fractionation, Radiation; D005260:Female; D049970:Graves Ophthalmopathy / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000528:radiation effects*; D011829:Radiation Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome