Comparison of the effects of orbital decompression in Graves' ophthalmopathy

Abstract

Introduction Graves' disease is an autoimmune disorder. One of the symptoms is an overgrowth of the soft tissues of the orbit. Orbital involvement can cause exophthalmos, diplopia, or vision loss. Treatment strategies include a surgical approach that limits the ailments mentioned above. Decompression can be achieved by reducing the amount of enlarged tissues (fat removal) or increasing the space for enlarged tissues (bone removal). Numerous authors discuss the advantages and disadvantages of various techniques in terms of reducing the exophthalmos, the number and persistence of complications, and the long-term prognosis. Materials and Methods A literature search of PubMed and the Poznan University of Medical Sciences Main Medical Library resources from 1993–2022 was performed. Thirty articles were reviewed with attention to the surgical treatment of Graves' ophthalmopathy. Results The main surgical techniques include fat decompression and bone wall decompression. The results of exophthalmos fat removal are characterized by a significant decrease in proptosis (5.45mm) with a small percentage of newly formed diplopia (9%). Bone reduction in the lateral wall of the orbit shows similar effects: reducing exophthalmos (4.33mm) and the newly formed diplopia, as with fat removal (3.7%). Bone reduction in the medial- lateral wall, medial- inferior- lateral wall, and medial–inferior wall shows a decrease in proptosis ( 4.9 mm, 4.6 mm, 3.77 mm) and a higher percentage of new-onset diplopia (18%, 15%, 28%). Conclusion The smallest amount of newly formed diplopia at the highest proptosis reduction occurs with the self-removal of fat or resection of the lateral orbital wall.