2001 an ocular odyssey: lessons learned from 25 years of surgical treatment for graves eye disease.

Graves eye disease (GED) is a serious autoimmune disorder that often results in orbital congestion, massive extraocular muscle enlargement, mechanical strabismus, and severe diplopia. Surgical treatment of this condition has often yielded unsatisfactory results and unique or unusual complications. At the University of Michigan, I have had the opportunity to participate in an interdisciplinary Graves eye disease center and provide medical and surgical care for strabismus and diplopia in a large number of these patients. The purpose of this study was to retrospectively review my experience with the surgical treatment of these patients to determine what works, what to expect, and how to avoid the pitfalls and complications that have been common in the treatment of these patients. A retrospective review of the charts of all patients with GED and strabismus or diplopia seen between 1982 and 2001 and who had been followed for at least six months is reported. One hundred eighty-three charts were reviewed, of which 155 met inclusion criteria and 135 had undergone strabismus surgery. These provided the core population for this series. Charts were reviewed for demographics, clinical, and surgical characteristics with emphasis on the types of surgeries performed, surgical results, and complications. Results are organized in categories according to the lessons they have taught me. Special emphasis was placed on the relationship between orbital decompression and strabismus, between the size of strabismus angle and surgical success, and between the special features of GED as they relate to surgical complications and surgical success. I hope these lessons will assist others in the optimal care of these challenging patients.