Revision endoscopic orbital decompression in the management of Graves' orbitopathy

Abstract

Objective Endoscopic orbital decompression has proved to be an effective treatment for Graves' orbitopathy. In select patients, however, persistent or recurrent orbital symptoms necessitate additional therapy. The objective of this study is to determine the safety and effectiveness of revision endoscopic orbital decompression in patients with refractory Graves' orbitopathy. Study Design Case-control series. Setting Academic medical center. Methods The study population consisted of 10 patients with Graves' orbitopathy who underwent 13 revision endoscopic orbital decompressions (three bilateral cases) between 1991 and 2008. Outcome measures, including reduction in proptosis, improvement in visual acuity, and complication rates, were compared with a control cohort of 10 consecutive patients (16 orbits) who underwent primary endoscopic decompression during the same time period. Results Indications for revision decompression included exposure keratopathy (n = 8, 62%), optic neuropathy (n = 3, 23%), and gaze restriction (n = 2, 15%). There were no intraoperative complications. Mean reduction in proptosis was 1.4 mm less for patients who underwent revision decompression compared with primary cases (mean decompression 3.6 ± 1.0 mm vs 5.0 ± 2.1 mm, respectively), although this difference was not statistically significant ( P = 0.13). Visual acuity improved in 62 percent of revision cases, compared with 20 percent of primary cases ( P = 0.09). Rates for postoperative complications, which included sinusitis and frontal mucocele formation, were also similar between revision and primary decompression groups (38% vs 13% respectively, P = 0.17). Conclusions This report is the first to describe the endoscopic technique for revision orbital decompression. It appears to be a safe and effective procedure for the treatment of refractory orbitopathy in patients with Graves' disease.