Long-term results of four-wall orbital decompression for Graves' ophthalmopathy.

A long-term (average 5 years, 4 months) follow-up of four-wall orbital decompression for Graves' ophthalmopathy in 22 patients is presented. Surgical decompression was reserved for patients who failed to respond to medical therapy. Six patients had undergone previous limited surgical decompression (3-wall decompression in one patient, 2-wall decompression in 4 patients, and orbital floor resection in 1 patient). All patients had moderate to severe proptosis. Fifteen of the 44 eyes (34%) had visual acuity of 20/200 or less. There were only 6 eyes with normal visual acuity (20/20) preoperatively (13.6%). Postoperatively visual acuity was normal in 34 eyes (77%). Globe recession varied from 2 to 14 mm (mean 6.1 mm). Apart from diplopia, symptomatic improvement was noted in nearly all patients.