Optic neuropathy of graves disease: Results of transantral orbital decompression and long-term follow-up in 215 patients

PURPOSE: To review demographic characteristics, clinical features, and long-term outcomes of patients with optic neuropathy of Graves disease after transantral orbital decompression. DESIGN: Retrospective analysis of noncomparative interventional case series; long-term follow-up by questionnaire. METHODS: Medical record data (preoperative and postoperative assessments) were collected from patients who had transantral orbital decompression to treat Graves optic neuropathy. Responses to two follow-up questionnaires concerning patient satisfaction were evaluated. Statistical analysis (reflected as P values) compared preoperative and early postoperative (≤182 days) data. RESULTS: Between November 1969 and May 1989, 215 patients underwent transantral orbital decompression for Graves optic neuropathy. In 205 eyes with visual acuity of 20/40 or worse before decompression, visual acuity improved by 3 Snellen lines or more in 110 (54%) (P < .001). Of 291 eyes with visual field defects preoperatively, 120 (41%) had resolution, and 126 (43%) had improvement postoperatively (P < .001). Proptosis was reduced in 350 eyes by 4.4 ± 2.3 mm (mean ± SD) (P < .001). In 104 eyes, disk edema resolved in 72 (69%) and improved in 28 (27%). Responses to questionnaires mailed in 1990 and 2000 showed that 76% and 88% of respondents, respectively, were subjectively satisfied with the results of orbital decompression. CONCLUSIONS: Transantral orbital decompression appeared to be effective in treating optic neuropathy of Graves disease. Patient satisfaction was high at 10-year and 20-year follow-up.