PURPOSE: To investigate the results of graded decompression of orbital fat and walls in Graves' orbitopathy (GO) considering the degree of proptosis reduction at surgery and preoperative computed tomography (CT) findings. METHODS: This is a retrospective interventional case series. Graded orbital fat and wall decompression was performed in 90 orbits of 55 patients. In patients with enlarged extraocular muscles and minimal orbital fat proliferation in preoperative CT scans, one- or two-wall decompression of posterior orbit was performed with minimal fat excision. In other cases, the maximal amount of fat tissue was removed from the post-septal area to the apex. If the proptosis was not satisfactorily symmetrically reduced at surgery, one- or two-wall decompression was performed successively. Symmetric reduction of proptosis was consistently confirmed intraoperatively to assure that a desired amount of exophthalmos reduction was achieved. RESULTS: Four types of decompression were performed: fat only (group 1), fat and one-wall (group 2), fat and two-wall (group 3), and two-wall and minimal fat decompression (group 4). The mean preoperative Hertel value (20.6 +/- 2.8 mm) was reduced significantly at six months postoperatively (16.1 +/- 2.3 mm). Proptosis significantly decreased with a mean of 4.3 +/- 1.7 mm, and the reduction was greatest (5.1 +/- 2.1 mm) in group 3. In group 1, a significant correlation between Hertel change and the volume of resected orbital fat was found (r = 0.479). Diplopia was newly developed or aggravated postoperatively in eight patients, and six of these patients were in group 3. With the exception of one patient, visual acuity improved to nearly normal postoperatively in all patients with optic neuropathy. CONCLUSIONS: Graded orbital decompression of orbital fat and bony walls, as assessed by the degree of proptosis reduction during surgery, was effective and predictable with minimal complications in GO patients with vision-threatening or cosmetically disfiguring proptosis.
Adipose Tissue/*surgery ; Adult ; Aged ; Decompression, Surgical/*methods ; Female ; Follow-Up Studies ; Graves Ophthalmopathy/diagnosis/*surgery ; Humans ; Male ; Middle Aged ; Orbit/*surgery ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

PURPOSE: To investigate the results of graded decompression of orbital fat and walls in Graves' orbitopathy (GO) considering the degree of proptosis reduction at surgery and preoperative computed tomography (CT) findings. METHODS: This is a retrospective interventional case series. Graded orbital fat and wall decompression was performed in 90 orbits of 55 patients. In patients with enlarged extraocular muscles and minimal orbital fat proliferation in preoperative CT scans, one- or two-wall decompression of posterior orbit was performed with minimal fat excision. In other cases, the maximal amount of fat tissue was removed from the post-septal area to the apex. If the proptosis was not satisfactorily symmetrically reduced at surgery, one- or two-wall decompression was performed successively. Symmetric reduction of proptosis was consistently confirmed intraoperatively to assure that a desired amount of exophthalmos reduction was achieved. RESULTS: Four types of decompression were performed: fat only (group 1), fat and one-wall (group 2), fat and two-wall (group 3), and two-wall and minimal fat decompression (group 4). The mean preoperative Hertel value (20.6 +/- 2.8 mm) was reduced significantly at six months postoperatively (16.1 +/- 2.3 mm). Proptosis significantly decreased with a mean of 4.3 +/- 1.7 mm, and the reduction was greatest (5.1 +/- 2.1 mm) in group 3. In group 1, a significant correlation between Hertel change and the volume of resected orbital fat was found (r = 0.479). Diplopia was newly developed or aggravated postoperatively in eight patients, and six of these patients were in group 3. With the exception of one patient, visual acuity improved to nearly normal postoperatively in all patients with optic neuropathy. CONCLUSIONS: Graded orbital decompression of orbital fat and bony walls, as assessed by the degree of proptosis reduction during surgery, was effective and predictable with minimal complications in GO patients with vision-threatening or cosmetically disfiguring proptosis.
Adipose Tissue/*surgery ; Adult ; Aged ; Decompression, Surgical/*methods ; Female ; Follow-Up Studies ; Graves Ophthalmopathy/diagnosis/*surgery ; Humans ; Male ; Middle Aged ; Orbit/*surgery ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

PURPOSE: To report clinical characteristics of thyroid-associated ophthalmopathy (TAO) in patients who previously underwent total thyroidectomy for thyroid cancer or a benign mass of the thyroid. MATERIALS AND METHODS: Of the patients who were diagnosed with TAO from March 2008 to March 2012, we performed a retrospective chart review on those who had undergone total thyroidectomy for thyroid cancer or a benign mass of the thyroid before the occurrence of ophthalmopathy. RESULTS: Of the 206 patients diagnosed with TAO, seven (3.4%) met the inclusion criteria. The mean age of the subjects was 47.4 years, and all were female. Six patients were diagnosed with papillary thyroid cancer, and one was diagnosed with a benign mass. The duration between total thyroidectomy and onset of TAO ranged from 3-120 months (median 48 months). Ophthalmic manifestations varied among cases. Except for the patient who was diagnosed with a benign mass, all patients showed hyperthyroid status and were under Synthroid hormone treatment at the time of TAO development. Five of these six patients had positive levels of thyroid-stimulating hormone (TSH) receptor autoantibodies. CONCLUSION: TAO rarely develops after total thyroidectomy, and the mechanism of TAO occurrence is unclear. However, most patients showed abnormalities in thyroid function and TSH receptor autoantibodies.
Adult ; Aged ; Autoantibodies/blood ; Carcinoma ; Carcinoma, Papillary/immunology/surgery ; Female ; Graves Ophthalmopathy/*diagnosis/immunology ; Humans ; Male ; Middle Aged ; Postoperative Complications/etiology/immunology/pathology ; Receptors, Thyrotropin ; Retrospective Studies ; Thyroid Neoplasms/complications/*surgery ; Thyroidectomy/adverse effects/*methods ; Thyrotropin/blood ; Treatment Outcome