Purpose: To evaluate the short and long term results of a combined medial and inferior orbital walls decompression procedure, in cases of moderate and severe Graves' ophth almopathy. Methods: Seven patients having moderate and severe Graves' ophthalmopathy were selected. All patients did medial and inferior orbital wall decompression. Three cases did bilateral decompression procedure, giving a total of ten eyes. The medial wall decompression was done by direct medial canthal skin approach, while the inferior wall decompression was done through infertior fomix cul-du sac approach. Results: The amount of orbital decompression ranged from three to six mm with an average of 4.3 mm. Optic neuropathy, and exposure keratopathy symptoms and signs disappeared. No limitation in ocular motility was found in all the cases. Lacrimal sac injury happened during dissection of the medial wall in one patient, and temporary silicone intubation was done. Three cases developed infraorbital hypothesia after surgery, and disappeared after three months.
Two female patients complained from the disfigerment of the skin scar of the medial canthal incision.
Conclusion: The direct medial canthal skin approach for medial wall decompression together with transconjunctival inferior fomix cul-du sac approach for inferior wall decompression, in cases of moderate and severe Graves' ophthalmopathy is effective in reducing exophthalmos, and relieving optic nerve compression with very low morbidity.
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