TRANSNASAL ENDOSCOPIC ORBITAL DECOMPRESSION IN GRAVESʹ OPHTHALMOPATHY

Gravesʹ ophthalmopathy can cause proptosis, cosmetic problems, and visual impairment. The aim of this study was to assess the validity and limitation of transnasal endoscopic orbital decompression in Gravesʹ ophthalmopathy. Between 1997 and 2003, 20 female and one male patients with Gravesʹ ophthalmopathy underwent simultaneous bilateral transnasal endoscopic orbital decompression. All patients were nonresponders to medical management (including steroid therapy) but none of them received orbital irradiation. Preoperative and postoperative ophthalmologic examinations were recorded for all patients. In addition, photographs and CT scans of orbit and sinuses were done. After operation, visual acuity improved following orbital decompression with this technique. Diplopia in lateral gaze developed in 15 patients but only one of them required corrective surgery. The mean retrodisplacement was 4.1 mm that compares favorably with other series. After an average follow-up of 49 months, none of the patients developed sinusitis or mucocele. Endoscopic decompression provides excellent visualization without external incisions, and facilitates maximal decompression without the increased risk of hemorrhage, visual impairment, or infections.