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Aesthetic Refinements in the Treatment of Graves' Ophthalmopathy
William Abouhassan MD (1,2)
Gaby Doumit MD MSc (2,3)
Michael J Yaremchuk MD (3)
(1)Division of Plastic, Reconstructive & Hand/Burn Surgery, Department of Surgery, University of Cincinnati College
Division of Plastic, Reconstructive & Hand/Burn Surgery, Department of Surgery, University of Cincin
2012-02-14
Presenter: William Abouhassan, MD
Affidavit:
The entirety of the above work is the original work of the resident based on scholarly activity during training in plastic and reconstructive surgery.
Director Name: W. John Kitzmiller, MD
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics
How does this presentation meet the established conference educational objectives?
1. Conference participants will be able to demonstrate knowledge of current concepts in plastic and reconstructive surgery.
2. Participants will address new clinical science research, techniques, and procedures relevant to plastic and reconstructive surgery.
How will your presentation be used by practicing physicians in the audience?
The presentation will provide background on the pathophysiology, clinical manisfestations and surgical management of Graves' ophthalmopathy. It also presents our novel experience in a case series of patients with the addition of skeletal augmentation, to orbit decompression and fat reduction, in treating symptoms and improving periorbital aesthetics. Our surgical technique, results, and conclusions will be presented for the audience to learn from and potentially implement into practice.
Background: Graves' ophthalmopathy is a chronic autoimmune multisystem disorder causing increased intraorbital fat tissue and hypertrophic extra-ocular muscles. Proptosis, impaired ocular motility, diplopia, lid retraction, and impaired visual acuity up to optic neuropathy may occur. This paper presents the addition of skeletal augmentation, to orbit decompression and fat reduction, in treating symptoms and improving periorbital aesthetics.
Methods: Through a transconjuctival with lateral canthotomy incision, a balanced decompression of the orbit was executed by removing the medial wall, lateral wall, and medial floor. Intraorbital fat was excised. All patients underwent placement of porous polyethylene infraorbital rim implants to increase projection of the floor and improve the globe-cheek relationship. From 2002 to 2012, 13 patients (11 females, 2 males, 26 eyes) with Graves' ophthalmopathy underwent this operation at two institutions. Surgical outcomes were evaluated, specifically for improvements of proptosis, diplopia, dry eye symptoms, and cosmetic satisfaction.
Results: Postoperative follow-up ranged 6-120months (median=18months). Mean improvement in Hertel exophthalmometer was 54.1mm. Diplopia resolved in 3/13 (23%) cases. No patients had worsening diplopia. 12/13 (92%) patients discontinued use of eye lubricants. All patients had cosmetic satisfaction. One patient suffered temporary paresthesia to the inferior orbital nerve. There were no infections, hematomas or ocular complications.
Conclusion: Skeletal augmentation is a useful adjunct to orbital decompression and fat excision for treating Graves' ophthalmopathy. Balanced orbital decompression with infraorbital rim implants are reliable, effective, and safe with good lasting results. Improvements in ocular symptoms, personal well-being, and social life; with a high benefit–to–low-risk ratio, are demonstrated.
