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Outcome of orbital decompression for disfiguring proptosis in patients with Graves’ orbitopathy using various surgical procedures
  1. Maarten P Mourits (m.p.mourits{at}amc.uva.nl),
  2. Heico M Bijl (h.m.bijl{at}amc.uva.nl),
  3. Lelio Baldeschi (l.baldeschi{at}amc.uva.nl),
  4. Kostas Boboridis (kosbob{at}otenet.gr),
  5. Nicola Curro (nicolacurro{at}virgilio.it),
  6. Jane Dickinson (jane.dickinson{at}nuth.nhs.uk),
  7. Anja K Eckstein (anja.eckstein{at}uk-essen.de),
  8. C Guastella,
  9. M Altea,
  10. George Kahaly (kahaly{at}endokrinologie.klinik.uni-mainz.de),
  11. M Freidel,
  12. Rachel Kalmann (r.kalmann{at}umcutrecht.nl),
  13. Gerasimos E Krassas (krassas{at}the.forthnet.gr),
  14. Carol Lane (carol.lane{at}cardiffandvale.wales.nhs.uk),
  15. J Lareida,
  16. Claudio Marcocci (c.marcocci{at}tin.it),
  17. M Marino (m.marino{at}endoc.med.unipi.it),
  18. Marco Nardi (marco.nardi{at}med.unipi.it),
  19. Ch Mohr,
  20. Christopher Neoh (christopher.neoh{at}nuth.nhs.uk),
  21. A Pinchera (a.pinchera{at}endoc.med.unipi.it),
  22. Jacques Orgiazzi (jacques.orgiazzi{at}chu-lyon.fr),
  23. Susanne Pitz (pitz{at}augen.klinik.uni-mainz.de),
  24. Peerooz Saeed (p.saeed{at}amc.uva.nl),
  25. Mario Salvi (mariosalvi{at}mariosalvinet.191.it),
  26. S Sellari-Franceschini,
  27. Mattheus Stahl (mstahl_ol{at}spital.ktso.ch),
  28. Georg von Arx (georg.vonarx{at}admedico.ch),
  29. Wilmar Wiersinga (w.m.wiersinga{at}amc.uva.nl)
  1. Academic Medical Centre, Amsterdam, Netherlands
  2. Academic Medical Centre, Amsterdam, Netherlands
  3. Orbital Centre, AMC, University of Amsterdam, Netherlands
  4. Aristotle University of Thessaloniki, Greece
  5. Fondazione Ospedale Policlinico Instituto di Ricovero e Cura a Carattere Scientifico, Italy
  6. Newcastle upon Tyne Hospitals NHS Trust, United Kingdom
  7. University Essen, Germany
  8. Fondazione Ospedale Policlinico Instituto di Ricovero e Cura a Carattere Scientifico, Italy
  9. Azienda Ospedaliero Unversitaria Pisana, Italy
  10. Gutenberg University Hospital Mainz, Germany
  11. Centre Hospitalier Lyon-Sud, France
  12. University Medical Centre Utrecht, Netherlands
  13. Panagia General Hospital, Greece
  14. University Hospital of Wales Cardiff, United Kingdom
  15. Basedow.ch-Interdisziplinäres Zentrum für Endokrine Orbitopathie Olten, Switzerland
  16. Azienda Ospedaliero Unversitaria Pisana, Italy
  17. Azienda Ospedaliero Unversitaria Pisana, Italy
  18. Azienda Ospedaliero Unversitaria Pisana, Italy
  19. Essen University Clinic, Germany
  20. Newcastle upon Tyne Hospitals NHS Trust, United Kingdom
  21. Azienda Ospedaliero Unversitaria Pisana, Italy
  22. Centre Hospitalier Lyon-Sud, France
  23. Johannes Gutenberg-University Mainz, Germany
  24. Academic Medical Centre, Amsterdam, Netherlands
  25. Fondazione Ospedale Policlinico Instituto di Ricovero e Cura a Carattere Scientifico, Italy
  26. Azienda Ospedaliero Unversitaria Pisana, Italy
  27. Basedow.ch-Interdisziplinäres Zentrum für Endokrine Orbitopathie Olten, Switzerland
  28. Basedow.ch-Interdisziplinäres Zentrum für Endokrine Orbitopathie Olten, Switzerland
  29. Academic Medical Centre, Amsterdam, Netherlands

    Abstract

    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.

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