title: Results and predictability of fat-removal orbital decompression for disfiguring graves exophthalmos in an Asian patient population.
abstract: OBJECTIVE
  To evaluate proptosis reduction by fat-removal orbital decompression (FROD), to determine the incidence of postoperative diplopia, and to assess predictability of proptosis reduction per volume of resected orbital fat.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  One hundred and twenty patients (31 men; 89 women) with Graves ophthalmopathy were treated with FROD via the transforniceal approach on 222 orbits between April 2003 and April 2006. Fifteen (12.5%) patients exhibited preoperative diplopia; 105 (87.5%) were without diplopia; mean follow-up +/- standard deviation (SD) was 10.9 +/- 5.1 months (range, six to 37 months). Univariate and multivariate analyses were used to evaluate Hertel change with FROD by linear regression. The setting was thyroid eye disease special clinics at National Taiwan University Hospital.
  
  
  RESULTS
  Mean Hertel values +/- SD decreased from 20.3 +/- 1.8 mm (range, 16.5 to 26.0 mm) to 16.8 +/- 1.4 mm (range, 13.5 to 21.0). Mean proptosis reduction +/- SD was 3.6 +/- 1.0 mm (range, 1.5 to 7.5 mm). Mean volume of resected orbital fat +/- SD was 3.6 +/- 1.0 ml (range, 1.2 to 6.5 ml). New-onset diplopia was noted for 2.8% of patients after FROD. The final predictive equation for Hertel change is shown as: 0.72 x removal of intraconal fat (ml) - 0.001 x age (yrs) - 0.22 x gender (male, 1; female, 0) - 0.19 x preoperative diplopia (yes, 1; no, 0) + 1.02.
  
  
  CONCLUSIONS
  FROD can achieve reasonable proptosis reduction and can reduce incidence of new-onset diplopia for patients with disfiguring Graves exophthalmos. The volume of resected orbital fat correlates with mean Hertel value change. The amount of resected orbital fat may predict proptosis reduction.
authors.affiliation: Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chien-Hsiu
authors.initials: CH
authors.lastname: Wu
authors.forename: Tien-Chun
authors.initials: TC
authors.lastname: Chang
authors.forename: Shu-Lang
authors.initials: SL
authors.lastname: Liao
mesh_terms: D000273:Adipose Tissue / Q000601:surgery*; D000328:Adult; D003430:Cross-Sectional Studies; D019299:Decompression, Surgical / Q000379:methods*; D004172:Diplopia / Q000503:physiopathology; D005094:Exophthalmos / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome