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DOI: 10.1055/s-0029-1212187
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York
Thyroid-associated orbitopathy: Transpalpebral decompression by removal of intraorbital fat
Experience with 1362 orbits in 697 patients over 13 years* * Great part of this paper is taken from “Endocrine Ophthalmopathy: Surgical Treatment. Decompression by removal of intraorbital fat”. By Neven Olivari. Kaden Verlag, Heidelberg 2000 (in press)Publication History
Publication Date:
14 July 2009 (online)
Summary
From 1985 to 1998 at the Plastic Surgery Unit in Wesseling we carried out 1362 decompressions of the orbit on 697 patients with Graves' disease. Intraorbital fat was removed trough transpalpebral incision to achieve decompression. From this patients we have exact follow-up of 511 patients and 1000 orbits. (Follow-up from 6 months to 12 years, average 27 months.) Average history of disease was 3.8 years. Female 3.7 (0.5-30), male 4.0 (1-17).
Mean age was 45 (22-75) years. 92% of the patients were female and only 8% male. When we compared the results to a traditional decompression (with resection of one, two or more orbital walls), we found that the postoperative complication rate was significantly lower and the success rate much higher.
The exact causes of thyroid-associated orbitopathy (TAO) are still unknown; for this reason there is as yet no causal therapy. Despite considerable progress in understanding the pathophysiology of TAO, therapy has remained virtually unaltered over the last decades, viz. the following.
Conservative therapy:
a. corticosteroids
b. radiotherapy of the orbits
Surgical therapy:
Osteotomy of one, two, three, or 4 orbital walls in order to achieve the desired reduction of pressure on the optic nerve.
Key words
Graves' disease - decompression - fat removal