October - December 2012, Volume 8, Issue 4

Costan V, Costan R, Bogdanici C, Moisii L, Popescu E, Vulpoi C, Mogos V, Branisteanu D

Surgery for graves' ophthalmopathy: When and what for? The experience of Iasi

Acta Endo (Buc) 2012, 8 (4): 575-586
doi: 10.4183/aeb.2012.575

Introduction. Orbitopathy is a common extrathyroidal feature of Graves’ disease. Initial immune infiltration may be followed by irreversible fibrosis and hypertrophy of extraocular muscles, leading to exophthalmos, diplopia and optic nerve compression. Surgery can improve the quality of life by adapting orbit volume to its content through orbital expansion and/or decompression and through interventions for functional or aesthetical reasons. Aim. To evaluate the impact of orbit surgery on the evolution of Graves’ ophthalmopathy. Patients and Methods. Our series includes 21 patients, operated between 2006 and 2012 mainly for proptosis (16 cases) or diplopia (5 cases). Results. Emergency orbit decompression was performed in one patient in the acute phase due to vision loss, reversible after intervention. Orbital extraconal lipectomy was used in all patients, involving both intraconal and extraconal fat in five cases. Unilateral bone decompression was needed in two interventions. 7 patients developed upper eyelid retraction, treated with botulinum injection in the levator palpebrale. Another patient showed lower lid retraction, elongated with palatal mucosal graft. Conclusion. Adequate surgery should be chosen for each case in an integrated multidisciplinary approach. Both intraorbital fat removal and bone decompression could be concomitantly used in certain patients with severe orbitopathy. Surgery should be performed in stabilized orbitopathy, but emergency intervention might be beneficial in acute onset of vision loss due to optic nerve compression.

Keywords: Graves' disease, ophthalmopathy, orbitopathy, surgery, therapy.

Correspondence: Dumitru Branisteanu MD, PhD, “Gr.T.Popa” University of Medicine and Pharmacy Iasi-Endocrinology, 18 Vasile Conta, Iasi 700106, Romania, Email: dumib@hotmail.com