Early versus Late Orbital Decompression in Graves’ Orbitopathy

Baldeschi, Lelio; Wakelkamp, I. M. M. J.; Lindeboom, Robert; Prummel, M. F.; Wiersinga, Wilmar M.

doi:10.1016/j.ophtha.2005.10.060

Cited by 57 publications

(37 citation statements)

References 14 publications

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“…The one patient requiring strabismus surgery had 2 significant additional risk factors: a history of smoking and a history of prior orbital decompression, both predisposing the patient to a greater degree of restrictive strabismus. [11][12][13][14] Neuroimaging confirmed the presence of extraocular muscle involvement even among some of our patients without strabismus. This has been previously reported in both pediatric and adult populations.…”

Section: Discussionsupporting

confidence: 67%

Pediatric Graves' ophthalmopathy: The pre- and postpubertal experience

Holt

Hunter

Smith

et al. 2008

Journal of American Association for Pediatric Ophthalmology and

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Section: Discussionsupporting

confidence: 67%

Pediatric Graves' ophthalmopathy: The pre- and postpubertal experience

Holt

Hunter

Smith

et al. 2008

Journal of American Association for Pediatric Ophthalmology and

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“…When decompression surgery is performed on patients affected with moderate-to-severe and inactive GO, expected beneficial effects include reduction in exophthalmos periorbital puffiness (swelling and fat prolapse) and lid retraction. Results are generally proportional to the extent of osteotomies or fat removal and are not influenced by the time elapsed between GO duration and decompression surgery [119] or by previous radiotherapy [120]. Other positive effects of decompression include a decrease in intraocular tension and relief of pain, improvement in preexisting strabismus/requirement for subsequent surgical correction and cure of postural visual obscuration in patients with orbital and optic nerve microvasculopathy.…”

Section: Recommendationsmentioning

confidence: 99%

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

et al. 2016

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Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.

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“…However, orbital decompression can be considered also in patients with active GO who are intolerant or nonresponsive to GCs, if waiting for spontaneous inactivation of GO can potentially be hazardous for visual function. † Almost all studies show the efficacy and relative safety of orbital decompression (46,(94)(95)(96)(97)(98)(99)(100)(101); however, the available studies do not allow any meaningful comparison of the available techniques (93,94,100,101). † Eye muscle and lid surgeries are effective treatments for correcting diplopia and improving lid function and appearance.…”

Section: Box 8 Sight-threatening Corneal Breakdown In Gomentioning

confidence: 99%