title: Reasons for revision surgery after orbital decompression for Graves' orbitopathy.
abstract: OBJECTIVE
  An analysis of complications and causes of failure in orbital decompression necessitating a second operation.
  
  
  METHODS
  Between December 1992 and April 2007, 375 patients (719 orbits) were operated on using various techniques. Fourteen patients were initially operated on in our unit: 8 (group A1) were re-operated on after a short time due to complications connected with the decompression operation, 7 (group A2) were operated on after some time due to recurrence of the illness or unsatisfactory decompression (one patient is in both group A1 and A2). Five patients (group B) underwent a first operation elsewhere.
  
  
  RESULTS
  For group A1 the most serious complications were connected to the nasal approach. For group A2 the operations were performed either because of a neuropathy recurrence or for further proptosis reduction due to recurrence or patient dissatisfaction. Lack of preoperative data hinders conclusions about group B, apart from one patient where the operation had not resolved a serious optic neuropathy after decompression based on Olivari technique combined with three-wall operation according to Mourits and colleagues (1990).
  
  
  CONCLUSIONS
  We can deduce from group A1 that extreme attention is necessary during endonasal access, from group A2 that balancing the eyes is advisable, sacrificing maximum proptosis reduction to gain greater patient satisfaction, and from group B that decompression of the orbital apex is fundamental in the case of neuropathy.
authors: Department of Neuroscience, 1st ENT division, Sez., Otorinolaringoiatria 1 Universitaria, Ospedale S. Chiara – Via Savi 10, 56100 Pisa, Italy. s.sellari@med.unipi.it
authors: Stefano
authors: S
authors: Sellari-Franceschini
authors: Luca
authors: L
authors: Muscatello
authors: Veronica
authors: V
authors: Seccia
authors: Riccardo
authors: R
authors: Lenzi
authors: Amelia
authors: A
authors: Santoro
authors: Marco
authors: M
authors: Nardi
authors: Barbara
authors: B
authors: Mazzi
authors: Aldo
authors: A
authors: Pinchera
authors: Claudio
authors: C
authors: Marcocci