Staged operation for Graves' ophthalmopathy.

A four-staged operation is currently the most effective treatment available in the management of stable Graves' ophthalmopathy. This report describes the results of four-staged therapy in 51 patients with Graves' ophthalmopathy. Stage I, orbital decompression: 58 orbits in 32 patients underwent orbital decompression, with an average retroplacement effect of 4.2 +/- 2.2 mm (mean +/- SD). This procedure is effective to restore vision and correct the proptosis due to Graves' ophthalmopathy. Careful intraoperative titration of the retroplacement effect during orbital decompression is very important to achieve successful results. Stage II, strabismus surgery: 24 patients underwent strabismus surgery, including 11 with previous decompression surgery and six with previous simultaneous decompression and strabismus surgery. The overall success rate was 87% and previous decompression or strabismus surgery had no influence on the final results. Stage III, fissure width adjustment: 28 patients (45 eyes) received fissure width adjustment. Various procedures were performed and we found Müllerectomy with levator muscle stripping to be the most useful procedure for fissure width adjustment. The average improvement of fissure height was 3.1 +/- 1.8 mm. The rate of overall satisfactory results was 89%. There were five patients who received Staged IV cosmetic procedures with satisfactory results. Graves' ophthalmopathy is a chronic disease that needs thorough cooperation between doctor and patient. Careful evaluation of clinical parameters and individualized surgical goals are the keys to success.