Orbital decompression in graves’ disease

Abstract

Objectives: Orbital decompression in the treatment of Graves’ ophthalmopathy can be achieved by partial or complete removal of one or more orbital walls or removal of retro-orbital fat. The choice of technique more often depends on the surgeon’s subspecialization, rather than patients’ needs. The most common complication of such surgery is represented by the onset or worsening of diplopia. Methods: The paper describes a technique used in 140 patients for complete removal of the medial orbital wall by ethmoidectomy and removal of the lateral wall by boring out the entire sphenoid wing. In order to achieve a more balanced displacement of the orbit after ethmoidectomy, sphenoid wing removal is associated with partial removal of the zygomatic bone and the orbital process of the frontal bone Results: Proptosis was reduced on average by 5 mm. Diplopia was unchanged in 55% of cases, worsened in 27% of cases, improved in 18% of cases. We observed 2 major intraoperative (CSF leak) and 1 major postoperative (meningitis) complications. No infections of the periorbita, cellulitis, damage to the first or second branches of trigeminal nerve occurred. Lateral wall-related damage to the meninx should not be considered major. Conclusions: The authors stress the importance of carefully weighing the preoperative conditions of the individual patient when choosing the surgical approach. Moreover, a decompression technique is advocated that spares the floor whenever possible and allows a individualized approach to the other orbital walls in order to minimize trauma and achieve more balanced decompression.