Objective: To evaluate the influence of strabismus surgery on quality of life (QoL) in Graves' orbitopathy (GO) patients. Design: Prospective study of case series. Methods: Consecutive GO-patients who were scheduled for their first strabismus surgery were included in the study. The patients completed the GO-QoL questionnaire within 3 months before the surgery and 2-4 months after the surgery. A complete orthoptic examination, including the field of binocular single vision (BSV), was performed. Clinically relevant response (CRR) in the QoL was also evaluated. Results: In this study, 28 patients were included. The GO-QoL score for visual functioning was 46.3G24.2 before surgery and 65.7G30.5 after surgery (PZ0.009). The GO-QoL score for appearance changed from 60.6G25.9 to 69.5G24.2 (PZ0.005). After surgery, the field of BSV increased from 24.3G34.8 to 68.5G36.0 points (PZ0.000). A weak correlation was found between the field of BSV and the visual functioning score after surgery (rZ0.417; PZ0.034). CRR was found in 20 (71%) patients. Those with a CRR showed a larger field of BSV (PZ0.002) and better GO-QoL scores (PZ0.008). Conclusions: GO-QoL score increases significantly for both visual functioning and appearance after the first strabismus surgery in GO-patients, showing the highest improvement for the visual functioning questions. Both the GO-QoL and field of BSV outcomes correlate well with the CRR.
Due to increased muscle tightness, recessions are the first choice of surgical procedures. Dosing is the most difficult part of the surgery. Several techniques are described: deviation-correction with preoperative determination of the dose, duction-correction either by active or passive intraoperative evaluation of ductions, and the application of adjustable sutures. Achievable success rates are comparable among these techniques but are dependent on the surgeon's experience. Cyclotorsion and misalignment after decompression and combined horizontal and vertical misalignments are more challenging to correct. Those types of deviations need special solutions like surgery on the oblique muscles and the usage of implants. The field of binocular single vision is the main outcome criteria for success, and the quantification may differ for research questions, study designs, and clinical purposes.
Bilateral recession of the inferior rectus muscles in patients with Graves orbitopathy results in a shift of vertical duction range toward upgaze and a significant decrease of excyclodeviation. Overcorrection of cyclodeviation in downgaze has to be considered before planning this type of surgery. Poor preoperative elevation contributes to higher dose-effect responses. Considering all variables, the orthoptic picture does not change after 3 months of surgery.
ABSTRACT.Proposal of success criteria for strabismus surgery for patients with Graves' orbitopathy (GO) based on a systematic review of the literature. We performed a systematic search of OVID MEDLINE, OVID Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and the publisher subset of PubMed, to identify studies reporting on success criteria of strabismus surgery in GO. In addition, we handsearched several orthoptic journals and proceedings of strabismological congresses. Of the 789 articles retrieved, 42 articles described success criteria for strabismus surgery in GO. Most studies defined success in terms of a subjective diplopia-free field in primary and down gaze. Almost half of the studies used a graded scale (excellent, good, acceptable and failure) to describe the outcome of surgery. Three of the eligible studies described a tool to quantify the field of single vision in detail. Quality of life was not reported as an outcome measure in any of the published studies. In conclusion, success criteria for strabismus surgery in patients with GO are poorly defined and no consensus is available. The lack of standardization hampers comparative studies and thus the search for the best surgical treatment for diplopia in patients with GO. Therefore, we propose strict success criteria including a tool for quantification of remaining diplopia plus a disease-specific quality of life questionnaire (the GO-QoL).
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