Transconjunctival Fat Removal Combined With Conservative Medial Wall/Floor Orbital Decompression for Graves Orbitopathy

Purpose: To evaluate the utility of transconjunctival fat removal combined with conservative ("strut-sparing") bony medial/floor orbital decompression for Graves orbitopathy. Methods: Retrospective, noncomparative case series of 52 orbits in 28 patients that underwent decompression using this technique. Preoperative and postoperative exophthalmos, diplopia, logMAR visual acuity, and orbital symmetry were measured. Results: Reduction in exophthalmos up to 8 mm with a mean of 3.3 mm ( +/- 1.5 mm) was achieved for decompressed orbits (p < 0.001). Postoperative symmetry within 2 mm was achieved in all patients. Diplopia was improved in 4 patients (14%), unchanged in 23 (82%), and worse in 1 (4%). Mean logMAR visual acuity improved -0.11 units (p = 0.007). Conclusions: Orbital fiat removal combined with conservative ("strut-sparing") bony medial/floor orbital decompression via a single transconjunctival incision is an effective and efficient technique with minimal morbidity. (Ophthal Plast Reconstr Surg 2009;25:206-210)