Graves Ophthalmopathy: Results of Transantral Orbital Decompression Performed Primarily for Cosmetic Indications

Vahab Fatourechi, James A. Garrity, George B. Bartley, Erik J. Bergstralh, Lawrence W. DeSanto, Colum A. Gorman

Research output: Contribution to journalArticle

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Abstract

Purpose: Transantral orbital decompression is effective treatment for excessive proptosis and optic neuropathy due to Graves ophthalmopathy. In these sight-threatening circumstances, patients willingly accept the side effects of orbital decompression. When transantral orbital decompression is performed for cosmetic indications, patients' acceptance of side effects may be different. This study reports detailed results of transantral decompression for 34 patients in whom the indications were primarily cosmetic. Methods: The medical records of 34 patients with Graves ophthalmopathy who had transantral orbital decompression primarily for cosmetic indications were reviewed. Preoperative and postoperative physical features of the eyes were compared. Long-term assessment was formulated from follow-up examination and a follow-up questionnaire. Results: The most notable improvement was in the reduction of proptosis (mean decrease, 5.2 mm). The frequency of asymmetry of proptosis, however, did not improve. Asymmetry was more than 1 mm in 44% of patients preoperatively and in 54% postoperatively. Although the palpebral fissure was decreased by an average of 2.7 mm, upper lid retraction became worse in 12 (43%) of 28 eyes. Of 15 patients who had no diplopia preoperatively, continuous diplopia developed postoperatively in 73%. The patients underwent a total of 37 eye muscle operations and 31 eyelid operations after decompression. Of 29 patients who responded to a long-term follow-up questionnaire, 69% were satisfied with the appearance of the eyes and 31 % found it acceptable. No patient was dissatisfied. Symptomatic diplopia was present in 6.9% of patients at the time of the follow-up questionnaire. Conclusion: Transantral orbital decompression performed for cosmetic indications in Graves ophthalmopathy may need to be followed by eye muscle and lid operations. These procedures result in a high degree of patient satisfaction. However, a small percentage of patients experience persistent diplopia, despite multiple eye muscle procedures. Ophthalmology 1994;101:938-942

Original languageEnglish (US)
Pages (from-to)938-942
Number of pages5
JournalOphthalmology
Volume101
Issue number5
DOIs
StatePublished - Jan 1 1994

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Graves Ophthalmopathy
Decompression
Cosmetics
Diplopia
Exophthalmos
Eyelids
Muscles
Optic Nerve Diseases
Ophthalmology
Patient Satisfaction
Medical Records

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Graves Ophthalmopathy : Results of Transantral Orbital Decompression Performed Primarily for Cosmetic Indications. / Fatourechi, Vahab; Garrity, James A.; Bartley, George B.; Bergstralh, Erik J.; DeSanto, Lawrence W.; Gorman, Colum A.

In: Ophthalmology, Vol. 101, No. 5, 01.01.1994, p. 938-942.

Research output: Contribution to journalArticle

Fatourechi, Vahab ; Garrity, James A. ; Bartley, George B. ; Bergstralh, Erik J. ; DeSanto, Lawrence W. ; Gorman, Colum A. / Graves Ophthalmopathy : Results of Transantral Orbital Decompression Performed Primarily for Cosmetic Indications. In: Ophthalmology. 1994 ; Vol. 101, No. 5. pp. 938-942.
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abstract = "Purpose: Transantral orbital decompression is effective treatment for excessive proptosis and optic neuropathy due to Graves ophthalmopathy. In these sight-threatening circumstances, patients willingly accept the side effects of orbital decompression. When transantral orbital decompression is performed for cosmetic indications, patients' acceptance of side effects may be different. This study reports detailed results of transantral decompression for 34 patients in whom the indications were primarily cosmetic. Methods: The medical records of 34 patients with Graves ophthalmopathy who had transantral orbital decompression primarily for cosmetic indications were reviewed. Preoperative and postoperative physical features of the eyes were compared. Long-term assessment was formulated from follow-up examination and a follow-up questionnaire. Results: The most notable improvement was in the reduction of proptosis (mean decrease, 5.2 mm). The frequency of asymmetry of proptosis, however, did not improve. Asymmetry was more than 1 mm in 44{\%} of patients preoperatively and in 54{\%} postoperatively. Although the palpebral fissure was decreased by an average of 2.7 mm, upper lid retraction became worse in 12 (43{\%}) of 28 eyes. Of 15 patients who had no diplopia preoperatively, continuous diplopia developed postoperatively in 73{\%}. The patients underwent a total of 37 eye muscle operations and 31 eyelid operations after decompression. Of 29 patients who responded to a long-term follow-up questionnaire, 69{\%} were satisfied with the appearance of the eyes and 31 {\%} found it acceptable. No patient was dissatisfied. Symptomatic diplopia was present in 6.9{\%} of patients at the time of the follow-up questionnaire. Conclusion: Transantral orbital decompression performed for cosmetic indications in Graves ophthalmopathy may need to be followed by eye muscle and lid operations. These procedures result in a high degree of patient satisfaction. However, a small percentage of patients experience persistent diplopia, despite multiple eye muscle procedures. Ophthalmology 1994;101:938-942",
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AB - Purpose: Transantral orbital decompression is effective treatment for excessive proptosis and optic neuropathy due to Graves ophthalmopathy. In these sight-threatening circumstances, patients willingly accept the side effects of orbital decompression. When transantral orbital decompression is performed for cosmetic indications, patients' acceptance of side effects may be different. This study reports detailed results of transantral decompression for 34 patients in whom the indications were primarily cosmetic. Methods: The medical records of 34 patients with Graves ophthalmopathy who had transantral orbital decompression primarily for cosmetic indications were reviewed. Preoperative and postoperative physical features of the eyes were compared. Long-term assessment was formulated from follow-up examination and a follow-up questionnaire. Results: The most notable improvement was in the reduction of proptosis (mean decrease, 5.2 mm). The frequency of asymmetry of proptosis, however, did not improve. Asymmetry was more than 1 mm in 44% of patients preoperatively and in 54% postoperatively. Although the palpebral fissure was decreased by an average of 2.7 mm, upper lid retraction became worse in 12 (43%) of 28 eyes. Of 15 patients who had no diplopia preoperatively, continuous diplopia developed postoperatively in 73%. The patients underwent a total of 37 eye muscle operations and 31 eyelid operations after decompression. Of 29 patients who responded to a long-term follow-up questionnaire, 69% were satisfied with the appearance of the eyes and 31 % found it acceptable. No patient was dissatisfied. Symptomatic diplopia was present in 6.9% of patients at the time of the follow-up questionnaire. Conclusion: Transantral orbital decompression performed for cosmetic indications in Graves ophthalmopathy may need to be followed by eye muscle and lid operations. These procedures result in a high degree of patient satisfaction. However, a small percentage of patients experience persistent diplopia, despite multiple eye muscle procedures. Ophthalmology 1994;101:938-942

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