Abstract
The surgical treatment of 144 patients (280 orbits) suffering from an endocrine orbitopathy with a mean preoperative proptosis of 24.5 mm was performed by removal of orbital fat. The early complication rate was low (12.4%). Symptoms due to the disease were significantly improved. The postoperative reduction in proptosis using this method was 5.5 mm at follow-up (mean: 3 years, range 1 to 7 years). No linear relationship between removed fat volume and reduction in proptosis was noted. Cases operated on within five years after the onset of the symptoms reverted to globe symmetry by removal of an equal fat volume from both orbits. Good results were achieved by removal of an unequal fat volume in patients with an asymmetric exophthalmos and a longer duration (>5 years) of the disease. The difference in the resected fat volume was 2 cc in favor of the most protruded side. In cases with pronounced proptosis (>26 mm) due to an increase of the extraocular muscles without significant increase of the fat volume the results with fat removal were poor. These patients are candidates for a combined approach using an osseous and fat decompression method.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bartalena L, Marcocci C (1983) Orbital cobalt irradiation combined with systemic corticosteroids for Graves' ophthalmopathy. J Clin Endocrinol Metab 56:1139–1144
Bite U, Jackson IT, Forbes GS, Gering BS (1985) Orbital volume measurements in enophthalmos using three-dimensional CT imaging. Plast Reconstr Surg 75:502–507
DeSanto LW (1972) Surgical palliation of ophthalmopathy of Graves' disease. Transantral approach. Mayo Clin Proc 47:989–992
Dobyns BM (1950) Present concept of pathologic physiology of exophthalmos. J Clin Endocrinol 10:1202–1225
Forbes G (1986) Ophthalmopathy of Graves' disease. Am J Neuroradiol 7:651–656
Gorman CA, DeSanto LW MacCarthy CS, Riley FC (1974) Optic neuropathy of Graves' disease. Treatment by transantral or transfrontal orbital decompression. N Engl J Med 10:70–75
Härting F, Koornneef L, Peeters HJ, Gillisen JPA (1989) Decompression surgery in Graves' orbithopathy — a review of 14 years experience at the Orbita Centrum, Amsterdam. Dev Ophthalmol 20:185–198
Hecht SD, Guibor P, Wolfley D, Wiggs EO (1984) Orbital dissection defatting technique for Graves' disease. Ann Ophthalmol 16:314–318
Hurwitz J, Rosenstock T (1983) Management of inadequate transantral orbital decompression with extended lateral orbitotomy. Can J Ophthalmol 18:194–196
Kennerdell JS, Marcoon JC (1982) An orbital decompression for severe dysthyroid exophthalmos. Am Acad Ophthalmol 89:467–472
Lamas G, Girard B, Rousselie F, Soudant J, Sénéchal G, Chic M (1988) Traitement des séquelles de l'ophthalmopathie basedowienne. Ann Otol-Laryngol 105:309–312
Lamberg BA, Grahne B, Tommila V, Pelkonen R, Rinne J, Liesmaa M, Välimäki M (1985) Orbital decompression in endocrine exophthalmos of Graves' disease. Acta Endocrinol 109:335–340
Leone ChR, Piest KL, Newman RJ (1989) Medial and lateral wall decompression for thyroid ophthalmopathy. Am J Ophthalmol 108:160–166
Linberg JV, Anderson RL (1981) Transorbital decompression. Arch Ophthalmol 99:113–119
MacCarthy CS, Kenefick ThP, McConahey WM, KearnsThP (1970) Ophthalmopathy of Graves' disease treated by removal of roof, lateral walls, and lateral sphenoid ridge: review of 46 cases. Mayo Clin Proc 45:488–493
McCord CD (1981) Orbital decompression for Graves' disease. Am Acad Ophthalmol 88:533–541
Ogura JH, Thawley SE (1980) Orbital decompression for exophthalmos. Otolaryngol Clin North Am 13:29–38
Olivari N (1991) Transpalpebral decompression of endocrine orbithopathy (Graves' disease) by removal of intraorbital fat: experience with 147 operations over 5 years. Plast Reconstr Surg 87:627–641
Peyster RG, Ginsberg F, Silber JH, Adler LP (1986) Exophthalmos caused by excessive fat: CT volumetric analysis and differential diagnosis. Am J Radiol 146:459–464
Riley FC (1972) Orbital pathology in Graves' disease. Mayo Clin Proc 47:975–979
Roncevic R, Jackson IT (1989) Surgical treatment of thyrotoxic exophthalmos. Plast Reconstr Surg 84:754–760
Rundle FF, Prochin E (1994) The orbital tissues in thyrotoxicosis: a quantitative analysis relating to exophthalmos. Clin Sci 5:51–74
Shaw HJ (1980) Transantral orbital decompression for endocrine exophthalmos — an appraisal. J Laryngol Otol 94:1151–1163
Small RG, Meiring NL (1981) A combined orbital and antral approach to surgical decompression of the orbit. Am Acad Ophthalmol 88:542–547
Stranc M, West M (1988) A four-wall orbital decompression for dysthyroid orbitopathy. J Neurosurg 68:671–677
Trokel SL, Jakobiec FA (1981) Correlation of CT scanning and pathological features of ophthalmic Graves' disease. Ophthalmology 88:553–564
Walsh TE, Ogura JH (1957) Transantral orbital decompression for malignant exophthalmos. Laryngoscope 65:544–568
Warren JD, Spector JG, Burde R (1989) Long-term follow-up and recent observations on 305 cases of orbital decompression for dysthyroid orbithopathy. Laryngoscope 99:35–40
Wilson WB, Manke WF (1991) Orbital decompression in Graves' disease. Arch Ophthalmol 109:343–345
Wirtschafter J, Chu AE (1988) Lateral orbitotomy without removal of the lateral orbital rim. Arch Ophthalmol 108:1463–1468
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Stark, B., Olivari, N. Management of thyroid orbitopathy by removal of orbital fat: a long-term follow-up study. Eur J Plast Surg 19, 1–6 (1996). https://doi.org/10.1007/BF00209781
Issue Date:
DOI: https://doi.org/10.1007/BF00209781