Graves-Basedow ophthalmopathy surgical approaches: Open vs Endoscopic

Area of Science:

• Ophthalmology
• Endocrinology
• Surgical Innovation

Background:

• Graves-Basedow's disease (GBD) is an autoimmune disorder impacting the thyroid, frequently causing Graves-Basedow ophthalmopathy (GBO).
• GBO affects 40-90% of GBD patients, involving inflammatory and infiltrative orbital tissue changes.
• Surgical orbital decompression is a key treatment for managing GBO symptoms, particularly proptosis.

Purpose of the Study:

• To compare the clinical outcomes of classic open versus modern endoscopic orbital decompression for Graves-Basedow ophthalmopathy.
• To evaluate the efficacy of each surgical technique in reducing proptosis and improving ophthalmometric measurements.

Main Methods:

• A retrospective clinical study from 2011-2020 included 18 patients (36 orbits) with GBO.
• Patients were treated with open orbital decompression (2011-2014) or endoscopic transnasal approach (2015-2020).
• Pre- and postoperative ophthalmometry, proptosis reduction, and oculo-orbital index were statistically analyzed.

Main Results:

• Both surgical techniques significantly reduced exophthalmos, as evidenced by improved ophthalmometry and oculo-orbital index values.
• A mean proptosis reduction of 1.7 mm was observed across both groups.
• No statistically significant difference in clinical outcomes was found between the open and endoscopic techniques.

Conclusions:

• Surgical orbital decompression, regardless of technique, is effective in managing Graves-Basedow ophthalmopathy.
• The endoscopic transnasal approach is recommended for crowded apex syndrome due to its ability to decompress the orbital apex.
• For other GBO cases, the endoscopic technique offers cosmetic advantages (no scars) and can be considered a first-line option.