Is Exophthalmos Reduction Predictable in Graves’ Disease?

Literature Review

Book with diagnosis Graves disease. Medical concept.Exophthalmos can occur in Graves’ disease, and it is possible to use decompression techniques to reduce it.  A study published in the December 2011 issue of the British Journal of Opthalmology examined the success of those decompression techniques; the article is “How predictable is exophthalmos reduction in Graves’ orbitopathy? A review of the literature.”

The study authors reviewed literature in PubMed from 1993 to 2010.  To be included, case series needed to have at least 10 patients in them.  It was also required that there be a thorough description of the surgical methods used, as well as detailed patient data.

The authors assessed:

  • patient demographics
  • amount of exophthalmos before surgery
  • surgical technique used
  • amount of exophthalmos reduction
  • complications

The review included 485 articles and 37 case series.

No matter which surgical technique was used, there was an average reduction of 4.45 mm in exophthalmos (range: -6 mm to 11 mm).

Which technique was used seemed to depend more on the surgeon’s background and preference, as opposed to objective criteria.  In one case series, the patients’ orbital anatomy was taken into consideration in regards to the surgical technique selected.

The authors have done a pilot study, and based on that data, they assume that intersubject variability in orbital morphology may impact the outcome of orbital decompression.

The authors concluded that the predictability of exophthalmos reduction may be improved by considering a patient’s orbital anatomy in defining outcome measures.  They also note that, to determine how significant orbital morphology intersubject variability is, there needs to be further clinical studies. 

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