Luigi C Clauser1, Manlio Galiè, Riccardo Tieghi, Francesco Carinci. 1. Unit of Cranio Maxillo Facial Surgery, Center for Craniofacial Deformities & Orbital Surgery, St. Anna Hospital and University, Corso Giovecca 203, 44100 Ferrara, Italy. csr@unife.it
Abstract
BACKGROUND: Endocrine Orbitopathy (EO) is the most frequent and important extrathyroidal stigma of Graves' disease. In the active stage of the orbitopathy fibrosis and hypertrophy of the extra-ocular muscles can lead to visual impairment and diplopia. In the stable phase of the disease surgical treatment by orbital expansion and/or orbital decompression can improve the quality of life and it is indicated for morpho-aesthetic and functional reasons. METHODS: From 1998 to 2009 a consecutive series of 131 patients (251 orbits) with endocrine orbitopathy underwent surgery by different techniques. The medical records of 102 patients (78%) and 196 orbits were available to be assessed retrospectively. Ninety-four patients had bilateral involvement of the orbits and eight unilateral. A total of 556 operations were performed. RESULTS: Mean pre-operative exophthalmos was 24.7 ± 2.5 mm (max-min 20-34), mean post-operative exophthalmos was 21 ± 1.8 mm (max-min 18-26), and mean differential exophthalmos was 3.9 ± 1.7 mm (max-min 1-9). The reduction in exophthalmos after surgery had a mean value of 3.8 mm (min 1, max 9). Kaplan Meier algorithm demonstrates that intra-operative cortisone injection had an adverse effect on post-operative diplopia. CONCLUSIONS: The surgical technique used should be adapted to the individual patients' needs. In severe cases intraorbital fat removal and bony decompression can be and carried out in one surgical procedure. An integrated global approach by a multidisciplinary team is strongly recommended. Strabismus surgery is a significant part of the overall treatment. The Authors suggest general surgical guidelines and an algorithm of treatment in EO.
BACKGROUND:Endocrine Orbitopathy (EO) is the most frequent and important extrathyroidal stigma of Graves' disease. In the active stage of the orbitopathy fibrosis and hypertrophy of the extra-ocular muscles can lead to visual impairment and diplopia. In the stable phase of the disease surgical treatment by orbital expansion and/or orbital decompression can improve the quality of life and it is indicated for morpho-aesthetic and functional reasons. METHODS: From 1998 to 2009 a consecutive series of 131 patients (251 orbits) with endocrine orbitopathy underwent surgery by different techniques. The medical records of 102 patients (78%) and 196 orbits were available to be assessed retrospectively. Ninety-four patients had bilateral involvement of the orbits and eight unilateral. A total of 556 operations were performed. RESULTS: Mean pre-operative exophthalmos was 24.7 ± 2.5 mm (max-min 20-34), mean post-operative exophthalmos was 21 ± 1.8 mm (max-min 18-26), and mean differential exophthalmos was 3.9 ± 1.7 mm (max-min 1-9). The reduction in exophthalmos after surgery had a mean value of 3.8 mm (min 1, max 9). Kaplan Meier algorithm demonstrates that intra-operative cortisone injection had an adverse effect on post-operative diplopia. CONCLUSIONS: The surgical technique used should be adapted to the individual patients' needs. In severe cases intraorbital fat removal and bony decompression can be and carried out in one surgical procedure. An integrated global approach by a multidisciplinary team is strongly recommended. Strabismus surgery is a significant part of the overall treatment. The Authors suggest general surgical guidelines and an algorithm of treatment in EO.