Orbital irradiation may not interfere with decompression surgery outcomes in Graves' orbitopathy

Orbital irradiation does not appear to affect the outcome of rehabilitative decompression surgery among patients with Graves' orbitopathy, according to a study by researchers in The Netherlands, published in the March issue of American Journal of Ophthalmology.

Lelio Baldeschi, MD, and colleagues at the University of Amsterdam retrospectively reviewed medical records of 376 patients with Graves' orbitopathy who were treated with a three-wall orbital decompression through a coronal approach between January 1990 and December 2000. Of these patients, the investigators subsequently evaluated medical records of 61 patients with no preoperative diplopia who had undergone bilateral surgery for aesthetic rehabilitation and had received either orbital radiotherapy alone, systemic glucocorticoids alone, or combined radiotherapy and glucocorticoids during the active phase of the disease.

Specifically, 29 patients in the orbital radiotherapy group received 20 Gy of radiation in 10 daily fractions of 2 Gy for 2 weeks, and 15 patients in the systemic glucocorticoids group received daily administration for more than 3 months independently from the dosage. Seventeen patients received combined radiotherapy and glucocorticoids.

All groups were compared for demographics, smoking habits, preoperative characteristics and surgical outcomes, including the onset of diplopia within 20° of the central position of gaze and variations in the peripheral field of diplopia, the authors noted.

The investigators found no differences between patients in the orbital radiotherapy group, the glucocorticoids group and the combined therapy group with respect to demographics or characteristics before decompression.

However, the number of smokers was significantly higher in the combined therapy group (P = .019), according to the study.

"We could not find differences in surgical outcome by comparing the three groups," the authors said.