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Long-term outcomes of orbital fat decompression in Graves’ orbitopathy
  1. Anny M Cheng1,2,
  2. Yi-Hsuan Wei3,
  3. Sean Tighe1,2,
  4. Hosam Sheha1,2,
  5. Shu-Lang Liao3,4
  1. 1 Ocular Surface Center, Miami, Florida, USA
  2. 2 Florida International University, Herbert Wertheim College of Medicine, Miami, Florida, USA
  3. 3 Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
  4. 4 School of Medicine, National Taiwan University, Taipei, Taiwan
  1. Correspondence to Dr Shu-Lang Liao, Department of Ophthalmology, National Taiwan University Hospital, No.7, Chung-Shan South Rd, Taipei, Taiwan; liaosl89{at}


Purpose To evaluate the long-term clinical efficacy of orbital fat decompression in treating proptosis in Graves' ophthalmopathy (GO).

Methods Retrospective review of 1604 eyes of 845 patients with symmetric (1518 eyes) and asymmetric (86 eyes) proptosis who received orbital fat decompression between 2003 and 2014. Changes in Hertel values were evaluated at baseline, 6 months postoperatively and yearly thereafter. Recurrence of proptosis, diplopia and other complications that required additional surgeries were documented and analysed. The surgical outcome was defined as complete success if there was proptosis reduction with no recurrence and improved or no diplopia. Partial success was considered if there was proptosis reduction without recurrence yet persistent or new-onset diplopia. Failure was considered if there was recurrence of proptosis regardless of diplopia. The patient’s quality of life was also evaluated as a long-term outcome.

Results After follow-up for 37.9±24.4 months, 1365 eyes (85.1%) achieved complete success, 219 eyes (13.7%) achieved partial success and 20 eyes (1.2%) had failure. Newly onset diplopia and secondary decompression occurrence rate remained low at 3.3% and 0.6%, respectively. The total proptosis reduction was 4.1±1.3 mm, which was consistent all through the intermediate and long-term (5–10 years) follow-up. The amount of orbital fat removal (4.5±1.1 mL) played a significant role in the long-term Hertel change. Importantly, the overall quality of life increased significantly for GO patients after undergoing orbital fat decompression.

Conclusions Orbital fat decompression has a long-term efficacy in correcting disfiguring proptosis with a low complication rate and without the need of secondary decompression procedures. This was also associated with a significant improvement in quality of life.

  • Decompression
  • Diplopia
  • Graves Ophthalmopathy
  • Orbital fat
  • Proptosis

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  • Contributors Conception of the study (S-LL); conduction of the surgery (S-LL); preparation of the manuscript (AMC, Y-HW, ST, HS and S-LL); all authors read and approved the final manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethics Committee of National Taiwan University Hospital, Taipei, Taiwan.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data generated or analysed during this study are included in this published article.