Aim: To compare the outcome of various surgical approaches of orbital decompression in patients with Graves’ orbitopathy (GO), receiving surgery for disfiguring proptosis.
Method: Data forms and questionnaires were analyzed of consecutive, euthyroid patients with inactive GO who had undergone orbital decompression for disfiguring proptosis in 11 European centres.
Results: Eighteen different (combinations of) approaches were used, the swinging eyelid approach being the most popular followed by the coronal and transconjunctival approaches. The average proptosis reduction for all decompressions was 5.0 ± 2.1 mm. After 3-wall decompression the proptosis reduction was significantly more than after 2-wall decompression. Additional fat removal resulted in more proptosis reduction. Complications were rare, the most frequent being worsening of motility, occurring more frequently after coronal decompression. The average change in quality of life in the appearance arm of the GO-QOL questionnaire was 20.5 ± 24.8 points.
Conclusions: In Europe, a wide range of surgical approaches is used to reduce disfiguring proptosis in patients with GO. The amount of proptosis reduction depends on the number of walls removed and whether or not fat is removed. Serious complications are infrequent. Worsening of ocular motility is still a major complication, but -in this series- was rare after the swinging eyelid approach.