Is incidence of diplopia after Fat Removal Orbital Decompression a predictive factor of choice of surgical technique for Graves' ophthalmopathy?

Dysthroid orbitopathy or Graves ophthalmopathy is a frequent pathologic condition five times more frequent in females than males. The main symptoms are: proptosis, motility disorders related to eye muscles fibrosis, eyelid retraction, lagophthalmos, and finally the more severe ones: compressive opti...

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Veröffentlicht in:Bulletin de l'Académie nationale de médecine 2003, Vol.187 (9), p.1649-58; discussion 1659-60
Hauptverfasser: Adenis, Jean Paul, Camezind, Philippe, Robert, Pierre-Yves
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container_end_page 58; discussion 1659-60
container_issue 9
container_start_page 1649
container_title Bulletin de l'Académie nationale de médecine
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creator Adenis, Jean Paul
Camezind, Philippe
Robert, Pierre-Yves
description Dysthroid orbitopathy or Graves ophthalmopathy is a frequent pathologic condition five times more frequent in females than males. The main symptoms are: proptosis, motility disorders related to eye muscles fibrosis, eyelid retraction, lagophthalmos, and finally the more severe ones: compressive optic neuropathy at the apex of the orbit, and corneal exposure. In order to reduce proptosis the classic approach is Bone Removal Orbital Decompression (BROD) either through eyelid skin, coronal, conjunctival, or endonasal approaches. Recently a new technique has been described by Olivari: Fat Removal Orbital Decompression (FROD). The purpose is to evaluate the incidence of diplopia after FROD and improve surgical indications for Graves' ophthalmopathy. 35 patients were included in this retrospective study (58 orbits). FROD (OLIVARI technique) was performed in all cases (23 bilateral surgery, 12 unilateral; 12 men, 23 women). All patients with optic neuropathy (severe Graves'ophthalmopathy) were eliminated because bone decompression was always performed. The ocular motility was examined before and after surgery by orthoptic screening. The average follow up was 18 months. Before FROD, 7 patients complained of moderate or severe diplopia: all remained with diplopia after FROD. After FROD 32% developed a new diplopia: only one patient remained with diplopia after strabismus surgery or adaptation by prisms glasses. Diplopia after BROD in moderate Graves' ophthalmopathy (with indications identical to our study) is reported from 23 to 34% in previous studies. Diplopia after FROD is a real risk whose incidence is identical after FROD and BROD and must be explained to each patient before surgical decision.
doi_str_mv 10.1016/S0001-4079(19)33857-9
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subjects Adipose Tissue - surgery
Adult
Aged
Decompression, Surgical - methods
Diplopia - epidemiology
Diplopia - etiology
Female
Graves Disease
Humans
Incidence
Male
Middle Aged
Orbit - surgery
Postoperative Complications
Prognosis
Retrospective Studies
title Is incidence of diplopia after Fat Removal Orbital Decompression a predictive factor of choice of surgical technique for Graves' ophthalmopathy?
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