Long-term efficacy of orbital decompression for compressive optic neuropathy of Graves' eye disease

In a retrospective evaluation of the long-term effect of transantral-ethmoidal decompression for compressive optic neuropathy, the authors evaluated visual acuity, visual fields, color vision, and motility in 30 patients (52 orbits) for a median follow-up period of 2.5 years (range, 0.6 to 6.5 years). Patients with preoperative visual acuity of 20/40 or better uniformly remained in this category and demonstrated an earlier stabilization of vision than those with poorer preoperative visual acuity. Of the ten patients whose preoperative visual acuity was 20/50 to 20/100, 80% attained acuity of 20/40 or better. In patients whose visual acuity was 20/200 or less (n = 7), 57% attained an acuity of 20/40 or better. The most common visual field defect was generalized constriction, which was noted in 43 of the 52 eyes (83%). After decompression, the preoperative visual field defect had improved or completely resolved in all but one case. Dyschromatopsia, noted in 20 eyes preoperatively, cleared in 17 (85%) postoperatively. Although the study showed that surgical decompression is beneficial, some patients may require additional modalities of treatment.