Graves' orbitopathy can lead to cosmetic
deformity, orbital
pain, and
visual impairment. Surgical intervention can improve
proptosis, cosmetic appearance of the eyelids, vision, and orbital
pain with minimal morbidity. Ten patients with dysthyroid orbitopathy underwent concurrent bilateral orbital decompressions. Of these, 9 underwent simultaneous bilateral endoscopic and transantral decompressions, and 1 had only bilateral endoscopic decompressions. Medical management of keratopathy was attempted before surgery. All patients were previously treated with radioiodine and high-dose
corticosteroids, and 2 patients had prior low-dose orbital irradiation. Preoperative and postoperative visual acuity, color vision testing, and measurement of
proptosis were recorded for all patients. In addition, photographs and CT scans of the orbit and sinuses were done. After surgery, visual acuity improved in 8 patients and remained unchanged in 2 patients.
Diplopia in the primary and downward gaze improved in 1 patient and remained unchanged in the 3 others who had it before surgery. Color vision deficits in the blue/yellow range were present in 8 patients before surgery and all reversed within 2 weeks after surgery.
Proptosis decreased by an average of 4.83 mm (range 4-7 mm) in patients undergoing the combined
decompression and decreased by 4 mm in the 1 patient who had the endoscopic
decompression only.
Ethmoid sinusitis developed in 1 patient but resolved with oral
antibiotics, and another patient had an asymmetric result requiring additional unilateral surgery, which corrected the asymmetry. Overall, this approach avoids external incisions and allows excellent visualization in the regions of the orbital apex and ethmoid roof, facilitating maximal
decompression without the increased risk of
bleeding or visual disturbances.