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  • Oculoplastics/Orbit

    Review of: Preoperative risk factors for proptosis recurrence after rehabilitative orbital decompression in Graves' orbitopathy patients

    Byeon H, Ko JS, Kikkawa D, et al. American Journal of Ophthalmology, in press 2023

    Identifying the risk factors for proptosis recurrence after orbital decompression for Graves orbitopathy may help surgeons decide the proper timing for this procedure.

    Study design

    In this retrospective observational study, data from 217 patients with low clinical activity scores who were treated at a single South Korean hospital were reviewed. All patients were operated on by a single surgeon.


    Over a mean follow-up period of 15.6 months, recurrence occurred in 5.1% of patients. On univariate analysis, elevated thyroid-stimulating hormone receptor antibody and thyroid-stimulating immunoglobulin levels correlated with an increased likelihood of proptosis recurrence. Other factors, such as age, gender, history of radiation therapy, total thyroidectomy, smoking, and duration of disease, were not associated with proptosis recurrence.


    Limitations are inherent to the nature of a retrospective study, and prospective data are necessary to confirm these findings. Additionally, the authors followed patients for a range of 3 to 30 months, and this interval may be too short to capture all cases of recurrence.

    Clinical significance

    This translational study may help to inform clinicians regarding the decision-making involved in orbital decompression. Potentially, antibody levels rather than clinical activity scores could be used by clinicians to determine when decompression should be performed. Additionally, patients should be educated regarding their individual likelihoods of recurrence, based on serologic testing results.

    Financial Disclosures: Dr. Edward Wladis discloses financial relationships with FuzeHub, Lions Eye Foundation (Grant Support) and Horizon Therapeutics (Consultant/Advisor; Lecture Fees/Speakers Bureau); and is a patent holder.