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M.H. Boyle, J.P. Tao, R.A. Burgett, R.T. Martin, W.R. Nunery; Orbital Decompression Treatment of Pediatric Graves’ Ophthalmopathy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3785.
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While thyroid induced ophthalmopathy and its treatment have been extensively described in adults, little is written regarding this disease in the pediatric age group. Moreover, the authors are not aware of any previous studies describing the surgical timing, techniques, or outcomes of orbital decompression in children. We reviewed the charts of pediatric patients presenting to an Oculoplastic subspecialty group with the diagnosis of Graves’ to help elucidate some clinical features of this special form of the disease.
Consecutive charts from 1990 to 2004 for pediatric patients with the diagnosis of Graves’ were reviewed. In patients who underwent decompression, data was gathered regarding the indication for surgery, surgical technique, changes in visual acuity, extra–ocular motility, level of proptosis, and/or any other negative outcomes.
Twenty–Four children between the ages of 5 and 18 were identified. On initial examination, no patients had evidence of afferent visual loss as demonstrated by pupillary reaction, visual field, or color plate testing. Four (17%) of the patients had motility abnormalities. Twelve (50%) of the above patients underwent surgery, resulting in 19 orbital decompressions. The indication for surgery was proptosis with exposure/irritation that was refractory to conservative therapy. The average Hertel measurement in this sub–group was 22.9 mm on the right and 23.1 mm on the left, with an average asymmetry of 2.7 mm. Patients received either a floor, two, or three wall orbital decompression. No intra–operative complications were encountered. After surgery, all patients maintained their pre–operative visual acuity, and noted improvement in their ocular comfort. In seven of the twelve patients, post operative care was continued for an extended period (7 mos–10 yrs). New onset diplopia was seen in one patient, in extremes of gaze only. Post operative Hertel measurements decreased by –4.8 mm on the right and –5.3 mm on the left. The average asymmetry was reduced to 0.2 mm.
When compared with adults, Graves' ophthalmopathy in children is a relatively benign disease process. It may, however cause significant proptosis which leads to symptoms of exposure as well as an unsatisfactory cosmetic appearance. Based on our series, orbital wall decompression was effective in decreasing proptosis, relieving exposure, and improving orbital symmetry in children. These procedures also were associated with a low surgical risk and morbidity. Further investigation is warranted.
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