The Influence of Previous Orbital Irradiation on the Outcome of Rehabilitative Decompression Surgery in Graves Orbitopathy

Consensus Statement of the European Group on Graves' Orbitopathy (EUGOGO) on Management of Graves' Orbitopathy

“…The theoretical concern that radiation-induced fibrosis may reduce orbital compliance and hence compromise subsequent therapies, is not supported by the available evidence (92,93).…”

“…However orbital decompression can also be considered in patients with active GO who are intolerant or nonresponsive to GCs, if waiting for spontaneous inactivation of GO can potentially be hazardous for visual function. Almost all studies show the efficacy and relative safety of orbital decompression (46,94-101); however, the available studies do not allow any meaningful comparison of the available techniques (93,94,100,101). Eye muscle surgery and lid surgery are effective treatments for correcting diplopia and for improving lid function and appearance.…”

Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO

“…† No RCTs have been performed to investigate specifically whether non-surgical treatments reduce the subsequent need for rehabilitative surgery, so this important question remains unanswered. † The theoretical concern that radiation-induced fibrosis may reduce orbital compliance, and hence compromises subsequent therapies, is not supported by the available evidence (92,93). If more than one procedure is required, the sequence should be as outlined above.…”

“…However, orbital decompression can be considered also in patients with active GO who are intolerant or nonresponsive to GCs, if waiting for spontaneous inactivation of GO can potentially be hazardous for visual function. † Almost all studies show the efficacy and relative safety of orbital decompression (46,(94)(95)(96)(97)(98)(99)(100)(101); however, the available studies do not allow any meaningful comparison of the available techniques (93,94,100,101). † Eye muscle and lid surgeries are effective treatments for correcting diplopia and improving lid function and appearance.…”

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

“…When decompression surgery is performed on patients affected with moderate-to-severe and inactive GO, expected beneficial effects include reduction in exophthalmos periorbital puffiness (swelling and fat prolapse) and lid retraction. Results are generally proportional to the extent of osteotomies or fat removal and are not influenced by the time elapsed between GO duration and decompression surgery [119] or by previous radiotherapy [120]. Other positive effects of decompression include a decrease in intraocular tension and relief of pain, improvement in preexisting strabismus/requirement for subsequent surgical correction and cure of postural visual obscuration in patients with orbital and optic nerve microvasculopathy.…”