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Old and new: evidence-based evaluation of interventions for Graves’ Orbitopathy
  1. Daniel G Ezra,
  2. Geoffrey E Rose
  1. Adnexal Department, Moorfields Eye Hospital and UCL Institute of Ophthalmology NIHR Biomedical Research Centre for Ophthalmology, London, UK
  1. Correspondence to Mr Daniel Ezra, Adnexal Department, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK; d.ezra@ucl.ac.uk

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Graves’ Orbitopathy (GO) is an orbital inflammatory disease that is estimated to affect between 25% and 50% of patients with autoimmune thyroid disease.1 GO displays stages of activity and quiescence, where both surgical and medical interventions are important. Current regimes for treatment of GO show wide regional variations, and there remain many unanswered questions about the choice, timing and efficacy of medical interventions: not only is the best form of medical treatment not known but there is also only very limited evidence to direct the optimum timing and approach for surgical decompression. In recent years, the Cochrane Eyes and Vision Group has received a growing interest in title requests for reviews concerning interventions for GO, there currently being three completed Cochrane reviews on GO2–4 and several at the protocol stage.

Boboridis and colleagues2 have analysed the evidence for orbital decompression, which has been performed since the 1950s5 for two main indications—aesthetic rehabilitation in burnt-out disease, and for relief of compressive optic neuropathy in sight-threatening GO. Many surgical approaches to orbital decompression have been described over the years, including transcoronal, transcranial, endoscopic endonasal, transantral, transcanthal and transconjunctival. In one trial based on patients with burnt-out disease, an endoscopic approach to the medial wall and floor …

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