Orbital fat removal. Decompression for Graves orbitopathy

Area of Science:

• Ophthalmology
• Surgical Innovation

Background:

• Orbital decompression traditionally involves bone removal, carrying risks like anesthesia, motility issues, and blindness.
• Alternative methods are sought to mitigate the morbidity associated with orbital wall resection.

Purpose of the Study:

• To evaluate the efficacy and safety of orbital fat decompression as a primary surgical approach for Graves orbitopathy.
• To compare the outcomes of fat removal versus bone decompression in reducing proptosis and associated symptoms.

Main Methods:

• Eighty-one patients with nonactive Graves orbitopathy underwent orbital fat decompression via anterior orbitotomies.
• Computed tomography (CT) scans guided the removal of distended orbital fat pockets.
• Bone decompression was reserved for specific cases of optic neuropathy or residual exophthalmos.

Main Results:

• An average proptosis reduction of 1.8 mm was achieved across 158 procedures in 81 patients.
• Greater reduction (3.3 mm) was observed in patients with initial Hertel measurements over 25.0 mm.
• Morbidity was minimal, with only two patients experiencing temporary inferior oblique motility impairment.

Conclusions:

• Orbital fat removal is a viable and less morbid alternative to bone decompression for managing proptosis in Graves orbitopathy.
• This technique effectively reduces proptosis, improves appearance, and alleviates symptoms with a favorable safety profile.