The "triple technique" for treating stable Graves' ophthalmopathy

Area of Science:

• Ophthalmology
• Plastic Surgery
• Endocrinology

Background:

• Graves' ophthalmopathy presents a spectrum of severity, from mild eyelid retraction to severe orbital disfigurement and vision loss.
• Management strategies vary based on clinical findings like congestion, myopathy, lid retraction, proptosis, and optic neuropathy.
• While bony orbital decompression is standard for severe cases, milder forms require tailored surgical solutions.

Purpose of the Study:

• To evaluate the efficacy of a combined surgical technique for mild to moderate Graves' ophthalmopathy.
• To present a less invasive alternative to bony orbital decompression for selected patients.
• To assess the aesthetic and functional outcomes and complication rates of the proposed surgical approach.

Main Methods:

• A combined surgical approach involving conservative orbital lipectomy, levator-Müller complex lengthening via marginal myotomies, and limited lateral tarsal apposition.
• Simultaneous bilateral procedures modulated to individual patient deformities.
• Performed under local anesthesia with sedation, allowing intraoperative monitoring and same-day discharge.

Main Results:

• Significant aesthetic and functional improvements were observed in 32 operated eyes from 16 patients.
• No complications were reported during the 6 to 18-month follow-up period.
• The procedure demonstrated high reliability and patient satisfaction.

Conclusions:

• The combined eyelid surgery and orbital lipectomy technique is a safe and effective treatment for mild to moderate Graves' ophthalmopathy.
• This approach offers a favorable alternative to more invasive procedures like transosseous decompression for patients without optic neuropathy or severe proptosis.
• The procedure's simplicity, low morbidity, and excellent outcomes make it ideal for improving both aesthetic and functional impairments.