[Surgical treatment of endocrine orbital disease. Indications, methods,results]

Surgical removal of the thyroid gland in Graves-Basedow's disease has, beyond doubt, also a major effect on endocrine orbitopathy. After total or near-total removal of the thyroid gland after three months a slighter deterioration or even ameloriation of ocular protrusion is found, contrary to the effect of subtotal thyroidectomy. There exists a significant correlation between the volume of the residual gland evaluated according to 24 h-uptake of 131I, and between the regression of the protrusion (r = 0.385, p < 0.01). Total or near-total thyroidectomy alone even in the absence of other therapeutic methods leads after 1 to 4 years to an average regression of the protrusion by 1 mm which matches the results of prednisone treatment, if the latter is used as the sole treatment. Orbital decompression by the modified method of Ogura and Walsh led in patients treated concurrently with prednisone and thyroidectomy to improvement of the visual acuity on average by 50% (from the range of 0.008 to 0.33 to values from 0.4 to 1.0) and to regression of the protrusion on average by 3.3 mm. When determining the time of operation of the oculomotor muscles, in addition to the unchanged ocular finding also the echographic picture in sectorial visualization proves useful.