Treatment of optic neuropathy and disfiguring proptosis by orbital decompression in patients with Graves' orbitopathy

ABSTRACT

Compressive optic neuropathy by apical muscle crowding is a rare, but serious complication of Graves' orbitopathy. Proptosis is a frequent and cosmetically disturbing effect of Graves' orbitopathy. Both conditions can be treated effectively and safely by orbital decompression. However, many different decompression techniques have been described and different complication rates have been reported. We present our results with the inferomedial and coronal decompression techniques. Four patients with dysthyroid optic neuropathy and 42 patients with disfiguring proptosis and / or retrobulbar pain underwent orbital decompression. Twenty-three were operated by an inferomedial approach and the same number by a coronal approach. The inferomedial approach was used in women with unilateral proptosis, bilateral but moderate proptosis and in men. The coronal approach was used in all other patients. In the inferomedial approach, the orbital floor and the anterior part of the medial wall are removed. In the coronal approach, a part of the lateral wall, the floor and a larger part of the medial wall are removed. All eyes operated because of optic neuropathy improved to almost normal vision. Patients operated because of disfiguring proptosis had a mean proptosis reduction of 3 mm after inferomedial decompression, and of 5 mm after coronal decompression; iatrogenic diplopia and paresthesia were the main but infrequent complications, occurring in 4 [9%] and 6 [13%] patients respectively. Inferomedial and coronal orbital decompression effectively combat dysthyroid optic neuropathy and disfiguring proptosis. The complication rates were favorable compared to other techniques