Reasons for revision surgery after orbital decompression for Graves’ orbitopathy

Stefano Sellari-Franceschini¹, Luca Muscatello¹, Veronica Seccia¹, Riccardo Lenzi¹, Amelia Santoro¹, Marco Nardi², Barbara Mazzi³, Aldo Pinchera³, Claudio Marcocci³

¹Department of Neuroscience, 1st ENT division, ²Ophthalmology Division, ³Department of Endocrinology and Metabolism, Orthopaedics and Traumatology, Occupational Medicine, University of Pisa, Italy

Objectives: An analysis of complications and causes of failure in orbital decompression necessitating a second operation.

Methods: Between December 1992 and April 2007, 375 patients (719 orbits) were operated on using various techniques. Fourteen patients were initially operated on in our unit: 8 (group A1) were re-operated on after a short time due to complications connected with the decompression operation, 7 (group A2) were operated on after some time due to recurrence of the illness or unsatisfactory decompression (one patient is in both group A1 and A2). Five patients (group B) underwent a first operation elsewhere.

Results: For group A1 the most serious complications were connected to the nasal approach. For group A2 the operations were performed either because of a neuropathy recurrence or for further proptosis reduction due to recurrence or patient dissatisfaction. Lack of preoperative data hinders conclusions about group B, apart from one patient where the operation had not resolved a serious optic neuropathy after decompression based on Olivari technique combined with three-wall operation according to Mourits and colleagues (1990).

Conclusions: We can deduce from group A1 that extreme attention is necessary during endonasal access, from group A2 that balancing the eyes is advisable, sacrificing maximum proptosis reduction to gain greater patient satisfaction, and from group B that decompression of the orbital apex is fundamental in the case of neuropathy.

Keywords: orbital decompression, Graves’ orbitopathy, revision surgery