Surgical management of Graves' ophthalmopathy: stage I, inferomedial orbital decompression

Inferomedial orbital decompression was done on 26 eyes with dysthyroid optic neuropathy (DON), seven eyes with corneal exposure which had not responded to topical lubricants, and six with disfiguring exophthalmos. Twenty-one of the 26 DON eyes (80.7%) had visual acuity improvement equal to or greater than two lines by the Snellen chart, and there was only one in all 39 eyes that dropped more than two lines. The average retinal sensitivity improvement was of borderline significance (4.25 +/- 5.73 dB), but for those 13 severely affected eyes (preoperative sensitivity loss > or = 10 dB), 11 (84.6%) of them showed significant improvement. There were 16 bilateral and seven unilateral cases. Out of all 39 eyes, the average retroplacement effect was 4.6 +/- 2.3 mm, and none of them had postoperative asymmetry greater than 2 mm by Hertel's exophthalmometry. Although the palpebral fissure height tends to remain the same after surgery, upper lid retraction is likely to be worse. The most frequent sequela was diplopia, which tended to occur in more severely myopathic eyes regardless of the surgical approach used. Although a staged approach is mandatory in surgical treatment of this disorder, individualization of surgical goals and intraoperative titration of the retroplacement effect are of equal importance for optimal results.