Outcomes following surgical decompression for dysthyroid orbitopathy (Graves' disease).
OBJECTIVE
Graves' disease is a multiorgan autoimmune disease of complex pathophysiology that primarily affects the thyroid gland and orbit. The ophthalmic manifestations of Graves' disease may vary from mild proptosis which causes minimal cosmetic embarrassment to subluxation of the globe, exposure keratitis, corneal abrasion and even blindness. This article focuses on outcomes following orbital decompression.


RESULTS
Surgical techniques have evolved with improved understanding of sinonasal anatomy and being technology-driven with the use of the fiberoptic endoscope and image guidance. The most common surgical outcome reported in the literature is reduction in proptosis, followed by visual acuity and intraocular pressure. Quality-of-life assessments are not routinely measured.


CONCLUSIONS
There are a myriad of surgical techniques currently in practice which underscores the fact that no single technique is clearly superior to another. Endoscopic decompression results in a mean reduction of 3.50 mm and is associated with a low complication rate. Nevertheless, the literature suggests that the best techniques are likely to be multiwall approaches such as combined medial and lateral wall decompression. Management of dysthyroid ophthalmopathy is clearly multidisciplinary. Future studies should consider a minimum data set for reporting outcome measures which should include a quality of life tool.
Leong
Samuel C
SC
Department of Paediatric Otolaryngology-Head and Neck Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, England, UK.
White
Paul S
PS
D019299:Decompression, Surgical; D005094:Exophthalmos / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D006111:Graves Disease / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D013508:Ophthalmologic Surgical Procedures / Q000379:methods; D010348:Patient Care Team; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology