Preoperative Risk Factors for Proptosis Recurrence After Rehabilitative Orbital Decompression in Graves’ Orbitopathy Patients

Purpose Rehabilitative orbital decompression treats disfiguring exophthalmos in Graves’ orbitopathy (GO) patients. This study aimed to identify risk factors associated with the postoperative recurrence of proptosis after orbital decompression. Design Retrospective case-control study Methods This retrospective review included patients with GO who underwent rehabilitative orbital decompression for disfiguring proptosis in an inactive state with a low clinical activity score (0-2) between Jan 2017 and Dec 2020 by a single surgeon. Exophthalmos was measured using a Hertel exophthalmometer, and recurrence was defined as an increase of 2 mm or more after decompression during the follow-up period. The association between preoperative variables and proptosis recurrence was analyzed using multivariable logistic regression. Results Of the total 217 patients, eleven (5.1%) developed recurrence of proptosis during the follow-up period (range 3-30, mean 15.6 months). Univariate logistic regression analysis identified thyroid-stimulating hormone receptor antibody (TRAb) and thyroid-stimulating immunoglobulin (TSI) as significant factors for recurrence with age, sex, smoking, disease duration, orbital radiotherapy, and total thyroidectomy history being non-significant. TRAb remained significant in a multivariate logistic regression analysis (OR 1.06; p=0.014). Receiver operating characteristic (ROC) curve analysis revealed an area under curve 0.86 with a sensitivity 90.9% and specificity 82.0% at TRAb level 7.96 IU/L. Conclusion Preoperative TRAb and TSI are valuable markers to predict proptosis recurrence after orbital decompression. These results may help surgeons to decide the optimal timing for orbital decompression to lessen the risk of postoperative recurrence of proptosis.