title: Retrobulbar ocular blood flow changes after orbital decompression in Graves' ophthalmopathy measured by color Doppler imaging.
abstract: OBJECTIVE
  To evaluate if decompression surgery produces changes in retrobulbar blood flow parameters in Graves' ophthalmopathy (GO).
  
  
  METHODS
  Retrobulbar blood vessels of 26 eyes (14 patients) that underwent orbital bone decompression between June 2009 and May 2010 were measured prospectively using color Doppler ultrasound before and after surgery. The disease was inactive in all patients enrolled according to the European Group on Graves' Orbitopathy. Patients were classified with mild, moderate-to-severe, or sight-threatening disease. All patients underwent a full ophthalmic examination including intraocular pressure and Hertel measurement. An age-matched control group included 20 eyes of 20 healthy volunteers.
  
  
  RESULTS
  The resistance indexes (RIs) in the central retinal artery (CRA) and ophthalmic artery (OA) were significantly higher in patients with GO preoperatively than in the control group (P < 0.001, P = 0.001 respectively). After decompression surgery, a significant decrease in RIs occurred in the CRA (5%) and OA (6%) (P = 0.002, P < 0.001 respectively). Proptosis was decreased a median of 6 mm (range, 4-7). Three-wall decompression surgery resulted in a significantly greater reduction in exophthalmos (median 7 mm) compared with two-wall surgery (median 5 mm) and one-wall surgery (2.5 mm). Although no significant correlation was found, the RIs decreased more with major reductions in exophthalmos.
  
  
  CONCLUSIONS
  In inactive moderate-to-severe GO, the RIs of the CRA and OA are higher than in normal subjects. The authors hypothesized that increased RIs of inactive GO may be due to orbital extrinsic compression of vascular structures because decompression surgery leads to decreases in the RIs of both the CRA and OA.
authors.affiliation: Ophthalmology Service, Ramon y Cajal Hospital, Madrid, Spain. marperlo@hotmail.com
authors.forename: Marta
authors.initials: M
authors.lastname: Pérez-López
authors.forename: Marco
authors.initials: M
authors.lastname: Sales-Sanz
authors.forename: Gema
authors.initials: G
authors.lastname: Rebolleda
authors.forename: Pilar
authors.initials: P
authors.lastname: Casas-Llera
authors.forename: Cristina
authors.initials: C
authors.lastname: González-Gordaliza
authors.forename: Elena
authors.initials: E
authors.lastname: Jarrín
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Muñoz-Negrete
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D005260:Female; D049970:Graves Ophthalmopathy / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging / Q000502:physiology*; D009915:Orbit / Q000098:blood supply; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D012161:Retinal Artery / Q000000981:diagnostic imaging / Q000502:physiology*; D012720:Severity of Illness Index; D018615:Ultrasonography, Doppler, Color; D014655:Vascular Resistance / Q000502:physiology