# Medial wall orbital decompression surgery for the treatment of Graves’ ophthalmopathy: follow-up results in a single medical center

## TL;DR

This study shows that endoscopic medial wall surgery effectively reduces eye bulging in Graves’ ophthalmopathy with minimal complications.

## Contribution

The paper presents a single-center follow-up analysis of endoscopic medial wall decompression for Graves’ ophthalmopathy.

## Key findings

- Endoscopic medial wall decompression significantly reduced proptosis by an average of 3.39 mm.
- Most surgeries were performed for proptosis, not optic neuropathy.
- No long-term complications were reported in the follow-up period.

## Abstract

To examine the success rate of endoscopic decompression surgery in Graves’ ophthalmopathy.

This is a retrospective cohort study of all patients who underwent endoscopic decompression surgery at the Rabin Medical Center, Israel, between 2010 and 2022. The data includes post-surgery follow-up time, visual acuity, proptosis outcomes, and post-surgical complications.

Thirty patients underwent unilateral or bilateral decompression surgery at our medical centre during the study period, a total of 42 eyes. The mean age at the time of decompression was 49 ± 15.82 years. The reason for surgery was proptosis in twenty-eight patients (93.3%), while only two patients (6.67%) were referred to surgery due to compressive optic neuropathy. The medial wall was decompressed in all of our patients either as a single procedure or in combination with other procedures. Thirteen patients (43.33%) underwent medial wall-only surgery, thirteen patients (43.33%) had medial and lateral wall surgery, and four patients (13.33%) had medial, lateral, and inferior wall decompression. The mean difference between pre-and post-op of the operated eye, measured by Hertel exophthalmometer, was 3.39 ± 2.45 mm (P < 0.001). The mean difference between the operated eye’s visual acuity between pre and post-op was 0.04 ± 0.21LogMAR (P = 0.19). The mean follow-up time for the Hertel measurement was 460.10 days (SD = 585.36). We do not report long-term surgical complications.

In the TED (thyroid eye disease) patient, endoscopic medial wall decompression can ensure sufficient orbital decompression while minimising complications. The size of the proptosis should be a factor when planning the surgery.