Medial and mediolateral orbital decompression in intractable Graves' Orbitopathy.
OBJECTIVE
Graves' Orbitopathy (GO) has well established treatment guidelines; however, its management is still controversial. The aim was to evaluate the results of medial and mediolateral orbital decompression (OD) in intractable GO.


METHODS
Retrospective chart review of all patients with advanced stages of GO, who underwent medial (1-wall) or mediolateral (2-wall) OD between May 2012 and November 2014 in our institution. Ophthalmologic examinations included visual acuity, Hertel exophthalmometry (proptosis), intraocular pressure (IOP), visual field (30:2) and diplopia. Follow-up was performed 1 week, 3 months and 1 year postoperatively. Additionally, a questionnaire was used to investigate subjective benefits.


RESULTS
The study included 34 eyes of 20 patients. In our study, GO patients who underwent mediolateral OD had significantly higher IOP preoperatively (p<0.05) and lower visual acuity, proptosis and visual field compared with patients who underwent medial OD. After 1- and 2-wall OD, visual acuity, proptosis, visual field and IOP in upgaze improved significantly. Using a questionnaire, the patients reported significant improvements in impaired vision, eye pain and pressure, vitality and social life. 94% of all patients reported they would repeat the operation. After 2-wall OD, the surgical scar had little effect.


CONCLUSIONS
With GO patients in advanced stages, both medial (1-wall) and mediolateral (2-wall) OD procedures are convincing therapeutic options. In more advanced GO stages with high IOP, 2-wall OD should be prioritized, as mediolateral OD had superior long-term functional outcomes.
Department of Ophthalmology, Charité, University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Ira
I
Seibel
Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Veit Maria
VM
Hofmann
Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Hasibe
H
Sönmez
Department of Ophthalmology, Charité, University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Shideh
S
Schönfeld
Clinic of Otorhinolaryngology, Head & Neck Surgery, Kliniken Villingen-Schwenningen, Klinikstr. 11, 78052 Villingen Schwenningen, Germany.
Masen Dirk
MD
Jumah
Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Minoo
M
Lenarz
Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. Electronic address: annekatrin.coordes@charite.de.
Annekatrin
A
Coordes
D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D004172:Diplopia / Q000209:etiology; D005260:Female; D049970:Graves Ophthalmopathy / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014794:Visual Fields
Diplopia; Intraocular pressure; Orbital decompression; Proptosis; Visual acuity; Visual field