How predictable is exophthalmos reduction in Graves' orbitopathy? A review of the literature

Aim To give an overview on the currently performed decompression techniques in Graves' orbitopathy, its indications, outcome, complications and predictability. Methods A review of the literature was conducted (PubMed 1993-2010). Case series with a minimum of 10 patients, with a detailed description of surgical methods and available patient data, were included. Patient demographics, preoperative amount of exophthalmos, the surgical technique, reduction in exophthalmos and complications such as new-onset diplopia were assessed. Results 485 related articles were reviewed, and 37 case series were included in this survey. Irrespective of the surgical method, an average of 4.45 mm in exophthalmos reduction was reported with a wide range of -6 to 11 mm. The choice of the surgical technique rather seems to be a matter of the surgeon's background or preference than objective criteria. The individual orbital anatomy was considered in one case series only with regard to the choice of surgical technique. Based on their data on a pilot study, the authors assume that the intersubject variability of orbital morphology may have a relevant impact on the outcome of orbital decompression. Conclusion Consideration of the individual orbital anatomy in the definition of outcome measures may improve the predictability of exophthalmos reduction in Graves' orbitopathy. Further clinical studies are required to determine the significance of intersubject variability in orbital morphology for the predictability of exophthalmos reduction.