Transnasal endoscopic approach in the treatment of Graves ophthalmopathy: the value of a medial periorbital strip.

Objectives: Present our experience with orbital decompression using an endoscopic transnasal approach and test whether preservation of an anteroposterior periorbital strip overlying the medial rectus muscle can reduce the incidence of postoperative diplopia.

Patient And Methods: Retrospective, descriptive study conducted on 16 patients with Graves ophthalmopathy operated on with orbital decompression between 2004 and 2009.

Results: Twelve women and four men (mean age, 34.6 years), a total of 30 orbits, were operated. A medial periorbital strip along the medial rectus muscle was preserved in 13 patients. A single case (7.7%) presented postoperative diplopia. The mean reduction of proptosis was 4.3mm.

Conclusions: The endoscopic transnasal approach provides comparable results to those obtained with other techniques. The incidence of postoperative diplopia seems to decrease when an anteroposterior periorbital periosteal strip is preserved along the medial rectus muscle.