Fourteen years of orbital decompression in Graves' disease: A review of technique, results and complications

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Abstract
Orbital decompressions in patients with Graves' disease performed during the past 14 years at the Orbital Center Amsterdam are reviewed. Forty-seven orbits of 28 patients were decompressed; because of optic neuropathy or exposure keratitis. In three patients (six orbits) cosmetic reasons led to intervention. In 30 of the 31 patients, orbital decompression had a beneficial effect on vision and/or the proptosis. Increase of muscle imbalance was the most frequent complication. A three-wall decompression technique (lateral, inferior and medial), either by a periorbital or by a coronal approach also resulted in muscle imbalance, but less severe than by the earlier two-wall techniques (superior and lateral wall, or inferior and medial wall). The long period of follow-up enabled the authors to find late complications. In their group, three patients had a recurrence of highly inflammatory Graves' orbitopathy in the course of the years following successful decompression. It appears that if Graves' orbitopathy is associated with a decrease of visual acuity, it concerns a serious case and complications must be expected.