[Endocrine ophthalmopathy: surgical treatment]

Since the transpalpebral decompression of the orbit by removal of intraorbital fat was introduced in 1985, this technique has become the state of the art in surgical therapy for Graves' ophthalmopathy at the authors' institution. Our experience with a series of 3,210 orbital decompressions in 1,635 patients with endocrine ophthalmopathy represents the largest collective of such patients that has been published yet to our knowledge. Over time the technique has proved to be reliable, effective, safe, and easily performed by a trained and experienced oculoplastic surgeon with long-lasting results, leading to improvement not only in visual function but also in well-being and in patients' social life, with a high benefit to low risk ratio. The promising and satisfying results demonstrated earliest in 1988 have been confirmed in further evaluation at our clinic and others. In summary, this technique, which is associated with very low morbidity, is our method of choice in moderate to severe cases of exophthalmos and even in functionally asymptomatic patients with mild to moderate aesthetic impairment. However, it has to be emphasized that this complex and multifactorial disorder often requires a broad range of long-term medical attendance. Postoperatively the majority of patients showed significant improvements of ocular protrusion, diplopia, visual acuity, swelling of eyelids, headache and retrobulbar "burn". In very rare instances, the surgical technique can be performed as a one-stage procedure. In severe cases (proptosis >28 or extreme muscle hypertrophy), lipectomy can be combined with expansion of the bony orbital cavity (<1% patients).