 Print page |
 Email page |
Surgical removal of bone surrounding the eyes has long-term benefits in patients with Graves’ eye disease
The background of the study. Graves’ eye disease is characterized by inflammation and enlargement of the eye muscles and adipose tissue behind the eyes, which result in protrusion of the eyes (exophthalmos) and poor vision. One treatment for patients with severe Graves’ eye disease is surgical removal of some of the bone that surrounds the eyes (decompression of the orbits). This study was done to determine the long-term benefits of orbital decompression in patients with severe Graves’ eye disease.
How the study was done. The study subjects were 78 patients who had undergone orbital decompression between 1985 and 2000. The patients were asked about the present status of their eyes, including vision, eye pain, comfort, and appearance, scored on a 10-point visual analogue scale (1, poor; 10, good), and the presence of diplopia (double vision) before surgery and at the time of follow-up. Their visual acuity, degree of exophthalmos, and intraocular pressure were measured.
The results of the study. The average age of the 78 patients at the time of surgery was 49 years, and it was 54 years at the time of follow-up; 81 percent were women and 19 percent were men. Before surgery, 94 percent had hyperthyroidism, and all were euthyroid at the time of surgery.
The interval from the onset of eye disease to surgery was 1.3 years. Before surgery, they had been treated with adrenal steroid hormones or radiation. The indications for surgery were optic nerve changes, exophthalmos, and severe inflammation of the tissues surrounding the eyes.
At follow-up, on average 5 years later, the visual analogue score was lower than in age- and sex-matched normal subjects. The surgery was considered very helpful by 76 percent of patients, somewhat helpful by 15 percent, harmful by 3 percent, and of no effect by 6 percent. Both exophthalmos and intraocular pressure improved after surgery (Table). Visual acuity improved in 49 percent, did not change in 32 percent, and decreased in 19 percent. Sixty-seven percent had diplopia before surgery, which improved in 65 percent and increased in 23 percent, and 8 percent had the onset of diplopia after surgery.
| Table. Changes in Proptosis and Intraocular Pressure Five Years after Orbital Decompression in 78 Patients with Graves’ Ophthalmopathy.* | |||
Before Surgery |
After Surgery |
Change |
|
| Exophthalmos (mm) | 23 |
19 |
-4 |
| Intraocular pressure (mm Hg) | 20 |
16 |
-4 |
| *Values are averages for both eyes in each patient. | |||
The conclusions of the study. Surgical decompression of the orbits results in long-term decreases in exophthalmos and intraocular pressure and improvement in visual acuity in patients with severe Graves’ eye disease.
The original article. Jernfors M, Valimaki MJ, Setala K, Malmberg H, Laitinen K, Pitkaranta A. Efficacy and safety of orbital decompression in treatment of thyroid-associated ophthalmopathy: long-term follow-up of 78 patients. Clin Endocrinol (Oxf) 2007;67:101-7.
 Next Article: Serum thyrotropin concentrations are lower in older than in younger patients with hypothyroidism |
||
| Thyroid Digest Index | | | July 2007 Thyroid Digest |
