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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In this large series of medial rectus recessions in patients with Graves' disease we found significantly lower dose-effect response ratios as compared to other studies. The amount of abduction deficit does not influence outcome.

Be aware of a combination of mechanical, neurogenic, and sensory causes of diplopia. Check for factors influencing the absence of diplopia, such as trauma-related visual problems, abnormal head posture, or preexistent strabismus. The severity of the trauma does not always correlate with the impairment of motility or with the degree of diplopia. Always prescribe monocular eye movement therapy. Treat patients in the first period after trauma with press-on prisms or different types of occlusion, and plan follow-ups as is deemed necessary according to the diagnosis.