Objective and subjective outcomes of strabismus surgery in Graves' orbitopathy: a prospective multicentre study

Jellema, Hinke Marijke; Saeed, Peerooz; Mombaerts, Ilse; Dolman, Peter J.; Garrity, Jim; Kazim, Mike; Dhrami-Gavazi, Elona; Lyons, Christopher J.; Nieuwkerk, Pythia T.; Mourits, Maarten P.

doi:10.1111/aos.13367

Cited by 22 publications

(14 citation statements)

References 38 publications

(64 reference statements)

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“…This means that a sufficient precision can be achieved for these relatively small deviations (see BSV). Our results confirm that single muscle surgery has primarily a good prognosis in GO patients (Esser 1994;Esser & Eckstein 1999;Schittkowski et al 2004;Jellema et al 2017;Eckstein et al 2018). Much more complex is the situation for patients if single muscle surgery does not suffice: usually, there are two options, either to use implants or to weaken the contralateral antagonist.…”

Section: Surgical Resultssupporting

confidence: 79%

Primary and secondary superior rectus recessions to correct vertical deviations in Graves’ orbitopathy patients

Eckstein

Oeverhaus

Dekowski

et al. 2021

Acta Ophthalmologica

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Purpose: Patients with vertical strabismus and consecutive diplopia due to Graves' orbitopathy (GO) might need recession of the rectus superior muscle. The aim of this retrospective analysis is to provide dose-effect values and motility analysis for these patients. Methods: Dose-effect relations (deviation reduction in primary position per amount of recession in mm), monocular excursions and size of the field of binocular single vision (BSV) were evaluated in three different groups of patients. Group 1 (n = 33) patients with primary fibrosis of superior rectus muscle undergoing recession of the ipsilateral rectus superior, Group 2 (n = 14) superior rectus muscle recession after recession of inferior rectus on the contralateral eye and Group 3 (n = 15) simultaneous ipsilateral superior rectus recession and contralateral inferior rectus muscle recession. Surgery was performed using the dose-effect for inferior rectus recession of 4 prism dioptre (PD, D ) reduction/per mm recession and the intraoperative traction test. Results: Restoration of BSV in the central 20°of gaze could be reached in 88%, 79% and 67% of patients in the three groups, respectively. Restoration of BSV in downgaze (up to 30°) was a little less successful, 79%, 57% and 53%, respectively. The median dose-effect was 3.2 D reduction/mm recession in Group 1 (Spearman correlation r = 0.75, p < 0.0001) and 3.3 D /mm in Group 2 (n.s.) and 4 D /mm in Group 3 (r = 0.67, p = 0.016). The basis for the improvement was the symmetrization of ductions. Conclusion: If superior rectus recession is necessary in GO, higher dosing around 3 D reduction/per mm recession should be applied. In case of large deviations, combined vertical surgery (inferior rectus and superior rectus contralateral) is required and reasonable (low cyclotorsion). Single-step or two-step procedures lead to similar results.

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Section: Surgical Resultssupporting

confidence: 79%

Primary and secondary superior rectus recessions to correct vertical deviations in Graves’ orbitopathy patients

Eckstein

Oeverhaus

Dekowski

et al. 2021

Acta Ophthalmologica

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“…In 2015, Jellema 11 reviewed the literature and suggested two factors that define strabismus surgical success: measurement of the field of binocular single vision (BSV) with the Goldman perimeter and QoL questionnaire. In 2017, Jellema 28 demonstrated that both field of BSV and QoL need to be measured to describe outcomes of strabismus surgery in patients with TED.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and risk factors of surgical management of thyroid eye disease–related diplopia

Laezza

Concilio

Giordano

et al. 2022

European Journal of Ophthalmology

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Objectives: To evaluate the outcomes of strabismus surgery in patients with thyroid eye disease (TED) and to assess the influence of preceding treatments such as steroid administration, orbital decompression and radiotherapy. Methods: Retrospective study on a cohort of patients with TED undergoing strabismus surgery. Data collection included clinical features, smoking status, preceding steroid therapy, orbital radiation therapy and orbital decompression. Qualitative evaluation, assessing diplopia and quality of life and quantitative evaluation, assessing the eye misalignment were analysed 1 year after the last squint surgical procedure. Results: Seventy-nine patients were identified. Ninety-five surgical procedures were performed on 92 eyes. A significant overall improvement of ocular motility was registered ( p < 0.001, paired t-test). Forty-five (57%) patients had excellent outcomes, twenty-three (29%) had good outcomes and eleven (14%) had poor outcomes. The average number of muscles operated was significantly greater in patients who underwent orbital bone decompression (1.58 ± 0.63; p = 0.0082; 95% CI 1.413–10.214). Quantitative and qualitative outcomes were not associated with the preceding therapy: steroid ( p = 0.75), radiotherapy ( p = 0.95) or orbital bone decompression ( p = 0.25). The success rate was no different between adjustable and fixed sutures ( p = 0.8). Conclusion: Strabismus surgery in TED patients resulted in a high success rate in reducing diplopia and improving ocular motility. The success rate was not negatively associated with previous therapies. Indeed, resolution of diplopia required more squint procedures in patients who have previously undergone to orbital decompression.

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“…Jellema et al. () reported an increase in quality of life and binocular single vision after strabismus surgery; and a requirement of additional strabismus surgery in approximately 30% of the TAO patients. In our cohort, 14 patients (12%) were re‐operated within the 2 years.…”

Section: Discussionmentioning

confidence: 99%

Clinical evidence supporting the use of donor sclera as spacer material in complicated cases of strabismus surgery – retrospective evaluation of surgical results in 117 patients with thyroid‐associated ophthalmopathy or congenital strabismus

Thorisdottir

Blohmé

Malmsjö

2018

Acta Ophthalmologica

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Purpose: To examine the outcome of the use of donor sclera as spacer material in complicated cases of strabismus surgery. Methods: A retrospective cohort study on patients with complicated thyroidassociated ophthalmopathy (TAO) (n = 42) or congenital strabismus (n = 75). Patients underwent strabismus surgery during 1994-2014. The surgical results were evaluated in terms of the reduction in the angle of deviation, the need for reoperation, complications and patient satisfaction. Results: The majority of the TAO patients underwent surgery for vertical strabismus (n = 25). The vertical angle of deviation in the primary position was significantly reduced from a median of 23 prism dioptres (PD) to 2 PD (n = 35, p < 0.001). The horizontal angle of deviation in primary position for TAO patients with esotropia was significantly reduced, from a median of 35 PD to 2 PD (n = 17, p < 0.001). The majority of the congenital cases had horizontal strabismus (esotropia = 29, exotropia = 27). The angle of deviation in esotropia was reduced from a median of 29 PD to 8 PD (n = 36, p < 0.001) and in exotropia from 30 PD to 10 PD (n = 34, p < 0.001). Most of the patients were satisfied with the outcome of surgery, and only 12% required re-operation within 2 years. Conclusion: This is the first clinical study on the use of donor sclera as spacer material in complicated cases of strabismus surgery. The surgical results were good in terms of the reduction in the angle of deviation, the need for re-operation, complications and patient satisfaction, supporting the use of donor sclera for strabismus surgery.

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Objective and subjective outcomes of strabismus surgery in Graves' orbitopathy: a prospective multicentre study

Abstract: After strabismus surgery in GO patients, both the field of BSV and quality of life questionnaires increase. In approximately 30% of the patients, an additional strabismus surgery is performed. This second surgery significantly expands the field of BSV and the quality of life.

Cited by 22 publications

References 38 publications

Primary and secondary superior rectus recessions to correct vertical deviations in Graves’ orbitopathy patients

Primary and secondary superior rectus recessions to correct vertical deviations in Graves’ orbitopathy patients

Outcomes and risk factors of surgical management of thyroid eye disease–related diplopia

Clinical evidence supporting the use of donor sclera as spacer material in complicated cases of strabismus surgery – retrospective evaluation of surgical results in 117 patients with thyroid‐associated ophthalmopathy or congenital strabismus

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