Intraocular pressure changes after treatment for Graves’ orbitopathy

Abstract

Objective To evaluate the change in intraocular pressure (IOP) in subjects with Graves’ orbitopathy (GO) after orbital decompression, strabismus surgery, and orbital radiation. Design Retrospective case review. Methods The charts of 172 consecutive subjects from the Neuro-ophthalmology Service at Wills Eye Hospital (Philadelphia, PA) with GO who underwent either orbital decompression, strabismus surgery, or orbital radiation between 1994 and 1999 were analyzed. Subject age, gender, diagnosis of glaucoma in either eye, use of systemic steroids or topical glaucoma medications, procedure performed, and the preoperative and postoperative IOP (in primary position and upgaze) were evaluated. Results Of 116 eyes that underwent orbital decompression, the mean preoperative IOP was 21.6 ± 4.6 mmHg (standard deviation) in primary position and 27.9 ± 6.8 mmHg in upgaze. The postoperative IOP was 17.5 mmHg ± 3.0 mmHg in primary position and 20.1 ± 4.7 mmHg in upgaze, a decrease in IOP of 18.9% in primary position and 27.9% in upgaze ( P < 0.001). Subjects taking glaucoma medication or who had IOP greater than 21 mmHg demonstrated a significantly ( P < 0.001) greater reduction in IOP postoperatively. The mean preoperative IOP in the 32 subjects who had strabismus surgery was 18.5 ± 2.8 mmHg (primary position), and 24.7 ± 4.3 mmHg (upgaze). Postoperative IOP was 16.1 mmHg (primary position) and 16.9 mmHg (upgaze), a decrease of 2.4 mmHg (13.3%, P < 0.01 in primary position) and 7.8 mmHg (31.2%, P < 0.01 in upgaze). There was no statistically significant reduction in IOP after orbital radiation. Conclusions In the selected subgroup of subjects with GO who required intervention, orbital decompression and strabismus surgery resulted in a significant reduction in IOP in the early postoperative period, especially in subjects with preoperative IOP greater than 21 mmHg.