Surgical treatment of strabismus in thyroid eye disease: characteristics, dose–response, and outcomes

Honglertnapakul, Worawalun; Cavuoto, Kara M.; McKeown, Craig A.; Capó, Hilda

doi:10.1016/j.jaapos.2019.12.014

Cited by 11 publications

(6 citation statements)

References 10 publications

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“…Late overcorrection may occur instead after inferior rectus recession. A postoperative mean drift toward overcorrection (from 1.9 Δ to 3 Δ ) has been described ( 8 , 13 ). Several elements have been reported as significant prognostic factors for postoperative overcorrection, including duration and severity of orbitopathy, impaired contralateral elevation, and underestimation of increased ipsilateral superior rectus tone ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, achieving an optimal outcome may be challenging, especially in patients with combined horizontal and vertical deviations (5)(6)(7)(8). The success rate of strabismus surgery in TAO patients is extremely variable and reported reoperation rate is approximately 45% of cases (7,9,10).…”

Section: Introductionmentioning

confidence: 99%

“…Undercorrection is the most common reported complication of horizontal strabismus correction ( 11 , 12 ), and late overcorrection may occur after inferior rectus recession ( 8 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

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Long-term follow-up of surgical treatment of thyroid-associated orbitopathy restrictive strabismus

et al. 2022

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ObjectiveThyroid-associated orbitopathy (TAO) is the most frequent cause of extraocular muscle enlargement, with consecutive restrictive strabismus. The main muscles involved are inferior and medial rectus, resulting in horizontal esotropia and/or vertical strabismus. Surgery may either establish or improve binocular single vision. The aim of the present study is to describe long-term follow-up of patients who underwent horizontal or vertical TAO strabismus surgery.MethodsThis observational retrospective study included 29 patients suffering from either vertical or horizontal TAO strabismus and diplopia, of whom 11 underwent bilateral medial recti muscle recession (Group A) and 18 underwent unilateral inferior rectus muscle recession (Group B). The endpoint of the study was the assessment of changes in deviation angle and diplopia across four time points (baseline, 7 days, 6 months, and 24 months) in each group.ResultsIn Group A, the horizontal deviation angle significantly decreased 7 days after intervention (p < 0.001), without modifications overtime. In Group B, both deviation angles in primary and down-gaze position significantly decreased from baseline, both 7 days after surgery (p < 0.001) and at 6 months (p = 0.040). An overcorrection, with an inversion of vertical deviation angle, was observed across the different time points.ConclusionsHorizontal TAO strabismus correction leads to significant improvements of deviation angle and diplopia, with a stable undercorrection overtime. Inferior rectus recession leads to more unstable results, with a trend towards overcorrection limited to the first 6 months after surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term follow-up of surgical treatment of thyroid-associated orbitopathy restrictive strabismus

et al. 2022

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“…The overcorrection of IR recession via postoperative drift is common ( 123 , 128 ); it can be explained by impaired contralateral elevation and underestimation of the increased SR tone ( 129 ). Suggested approaches to mitigate the risk of consecutive hypertropia include planned surgical dosage reduction; a semi-adjustable hang-back approach toward large recessions; and a long horizontal, intrascleral simple hang-back for small recessions ( 130 ). Although bilateral MR recession is frequently used to correct horizontal diplopia, undercorrection may be associated with residual diplopia because the muscles are tight.…”

Section: Squint Surgerymentioning

confidence: 99%

“…Plager ( 131 ) found that larger-than-expected recessions were necessary to treat small deviations and smaller-than-expected recessions were required when treating large GO-associated deviations; surgeons must carefully consider the deviations. Generally, the recessions are 3-4 PD/mm for the IR and 3-5 PD/mm for the MR ( 116 , 130 ). Preoperative forced duction tests in all directions are useful.…”

Section: Squint Surgerymentioning

confidence: 99%

Update on the surgical management of Graves’ orbitopathy

et al. 2023

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Graves’ orbitopathy (GO) is a complex autoimmune disorder of the orbit that causes the eye to appear disfigured. GO is typically associated with Graves’ disease, an inflammatory autoimmune condition that is caused by thyrotropin receptor autoantibodies. Although our knowledge of the pathophysiology of GO has improved, its exact pathogenesis remains unclear. Some patients suffer from disfigurement, double vision, and even vision loss rather than hyperthyroidism. The disease severity and activity prompt different treatments, as the signs of GO are heterogeneous, so their management can be very complex. Despite medical advances, the first-line treatment for moderate-to-severe active GO is still glucocorticoids, while surgery can be critical for the treatment of chronic inactive GO. Surgery is sometimes required in the acute phase of the disease when there is an immediate risk to vision, such as in dysthyroid optic neuropathy. Most surgeries for GO are rehabilitative and subdivided into three categories: decompression, strabismus repair, and lid surgery. This review is a basic overview of the field, with up-to-date knowledge of the surgical techniques for GO. We review and summarize recent literature on the advances in surgery for GO to provide up-to-date insights on the optimal surgical treatment for GO.

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