Medial Rectus Tendon Elongation with Bovine Pericard (Tutopatch®) in Thyroid-Associated Orbitopathy: A Long-Term Follow-Up including Oculodynamic MRI

Abstract

Introduction To assess long-term efficacy of bimedial rectus tendon elongation with Tutopatch in thyroid-associated orbitopathy (TAO). Materials and Methods Retrospective chart review of 5 patients with TAO undergoing bimedial rectus recession with Tutopatch tendon elongation between 2009 and 2015. We analyzed horizontal squint angles, motility, field of binocular single vision, dose effect of surgery, and when possible oculodynamic MRI (OD-MRI). Dose effect and motility were compared to 4 TAO patients with conventional bimedial recession. Results and Discussion In the Tutopatch group, preoperative angles ranged from 14 to 120∆ (prism diopters) at distance and 12–120∆ at near. Mean dose effect was 3.63∆/mm for the distance and 3.43∆/mm for the near angle. All patients were orthotropic at final FU (ranging from 1 to 10 years). OD-MRI showed the elasticity of Tutopatch. In the conventional recession group, preoperative angles ranged between 18 and 35∆ at distance and 12–33∆ at near. At final FU, 2 patients had reverted to their underlying microesotropia <2∆, 1 patient was orthophor, and one was reoperated for a remaining esotropia of 14∆. Dose effect was 2.95∆/mm for the distance and 2.18∆/mm for the near angle. Motility improved in both groups even after 3 months. Conclusions Dose effect for medial rectus recessions with Tutopatch in TAO was higher than previously reported, presenting a good alternative to treat large squint angles while preserving good motility.

Histological Changes in Tendon Elongation with Bovine Pericardium

“…In addition, the manufacturerʼs reports [12] of revascularization, repopulation, and remodeling of the Tutopatch through the ingrowth of host cells can be supported in humans and is consistent with the lasting elasticity seen. It may explain the prolonged time to reach a stable angle, which is longer than that seen in conventional strabismus surgery [8,9]. Thus, our findings support the use of Tutopatch as a safe material for tendon elongations in strabismus surgery with a special potential in restrictive motility disorders.…”

Tendon elongation with bovine pericardium in strabismus surgery—indications beyond Graves’ orbitopathy

“…In this study tendon elongation with bovine pericardium was considered for a heterogeneous group of patients which was unlikely to show satisfying results with conventional eye muscle surgery only. Thereby the spectrum of indications for this special procedure has been broadened [13][14][15][16][17][18].…”

“…Within their study only five GO patients with bilateral medial rectus muscle elongation but up to 10 years follow-up were described. Four out of the patients had previous orbital decompression surgery [ 18 ].…”

“…3. Considering patients with esotropic DRS without previous surgery only (patients 16,18,19,21,25), the median preoperative squint angle was 40Δ (35 to 45Δ), the median absolute preoperative head turn was 25°(7 to 30°), and the abduction was before or just up to midline (median abduction − 5°, from − 10 to 0°).…”