Proposing a surgical algorithm for graduated orbital decompression in patients with Graves' orbitopathy

Area of Science:

• Ophthalmology
• Endocrinology
• Surgical Innovation

Background:

• Graves' orbitopathy is an autoimmune condition affecting the eye socket.
• Orbital decompression surgery aims to alleviate symptoms like proptosis and visual impairment.
• A graduated, individualized approach to surgery may optimize outcomes.

Purpose of the Study:

• To evaluate the effectiveness of a graduated orbital decompression technique.
• To assess the impact of this technique on proptosis reduction, diplopia, and visual function.
• To determine the morbidity associated with individually adapted orbital decompression.

Main Methods:

• Retrospective analysis of 542 patients (1018 orbits) treated between 2012 and 2020.
• Inclusion of patients undergoing graduated balanced orbital decompression.
• Preoperative and postoperative assessments including visual acuity, Hertel exophthalmometry, and orthoptic evaluation.

Main Results:

• Significant reduction in mean proptosis values post-surgery (p < 0.01).
• Normalization of Hertel measurements in 83.3% of patients.
• Improvement in visual acuity for patients with dysthyroid optic neuropathy (p < 0.01); new-onset diplopia occurred in 33.0%.

Conclusions:

• Individually adapted graduated orbital decompression is effective in managing Graves' orbitopathy.
• The technique successfully improves key disease parameters.
• The procedure is associated with low morbidity, offering a favorable risk-benefit profile.