Graves' orbitopathy (GO) is an disfiguring and disabling autoimmune condition. Sight-threatening GO is an most severe form and occurs in about 5% of patients with Graves' disease. It can cause blurred vision, color vision and vision function damage, and affects the quality of life. The goal of this retrospective cohort study is to propose a customized orbital decompression algorithm for patients with sight-threatening Graves'ophthalmopathy and to explore the therapeutic effect of customized orbital decompression in sight-threatening patients.

Inclusion Criteria:

• Sight-threatening patients undergoing interdisciplinary discussion and orbital decompression operation.
• The sight-threatening GO refer to those with DON, exposure keratitis or corneal breakdown.
• DON was diagnosed according to the following clinical findings including optic nerve head edema, visual field defect, impaired color vision, afferent pupil defect, retinal folds, radiologic evidence of apical optic nerve compression or globe subluxation.
• Diagnosis of exposure keratitis or corneal breakdown was made based on physical exam signs, e.g. microepithelial defects, abrasion or ulcer. A minimum follow-up of 12 months was required for inclusion.

Exclusion Criteria:

• Patients were excluded if exophthalmos, rather than acute visual loss, was the indication for surgery.
• Cases with a history of previous ocular surgery, glaucoma, and visual defects from other ocular conditions were excluded from the study.

This was a retrospective cohort study of patients with sight-threatening Graves orbitopathy (GO) who underwent customized/individual multiple orbital wall decompression plus fat removal at Sun Yat-Sen Memorial Hospital from Jan. 2017 to Dec. 2021.

Medical records or outpatient examination records cannot be shared by hospitals across the country.