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Someda SK, Umezawa N, Vaidya A, Kakizaki H, Takahashi Y. Surgical Outcomes of Bilateral Inferior Rectus Muscle Recession for Restrictive Strabismus Secondary to Thyroid Eye Disease. J Clin Med 2023; 12:6876. [PMID: 37959341 PMCID: PMC10648423 DOI: 10.3390/jcm12216876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
This retrospective, observational study examined the surgical outcomes of bilateral inferior rectus (IR) recession in thyroid eye disease. Twelve patients who underwent bilateral IR muscle recession were included in the study. Surgical success was defined as patient achievement of the following conditions: (1) a postoperative angle of vertical ocular deviation of ≤3°; (2) a postoperative cyclotropic angle of ≤2°; (3) postoperative binocular single vision, including the primary position; and (4) postoperative enlargement of the field of binocular single vision. Linear regression analyses were performed to analyze the relationship between postoperative changes in the vertical and torsional ocular deviation angles and the amount of IR muscle recession and nasal transposition. Consequently, 9 out of 12 patients were deemed to have had successful surgical outcomes. There was a positive correlation between a change in the vertical deviation angle and a side-related difference in the amount of IR muscle recession in successful cases (crude coefficient, 2.524). A positive correlation was also found between a change in the torsional deviation angle and the amount of IR recession (crude coefficient, 1.059) and nasal transposition (crude coefficient, 5.907). The results will be helpful to more precisely determine the amount of recession and nasal transposition of the IR muscle in patients with thyroid-related bilateral IR myopathy.
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Affiliation(s)
- Steffani Krista Someda
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute 480-1195, Aichi, Japan; (S.K.S.); (N.U.); (A.V.); (H.K.)
| | - Naomi Umezawa
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute 480-1195, Aichi, Japan; (S.K.S.); (N.U.); (A.V.); (H.K.)
- Department of Ophthalmology, Aichi Medical University, Nagakute 480-1195, Aichi, Japan
| | - Aric Vaidya
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute 480-1195, Aichi, Japan; (S.K.S.); (N.U.); (A.V.); (H.K.)
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Kirtipur Eye Hospital, Kathmandu 44600, Nepal
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute 480-1195, Aichi, Japan; (S.K.S.); (N.U.); (A.V.); (H.K.)
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute 480-1195, Aichi, Japan; (S.K.S.); (N.U.); (A.V.); (H.K.)
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Huang Y, Li K, Yan Y, He J, Chen J. Strabismus surgery for improving the quality of life of strabismus patients with thyroid-associated ophthalmopathy. Medicine (Baltimore) 2023; 102:e34778. [PMID: 37657062 PMCID: PMC10476816 DOI: 10.1097/md.0000000000034778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/26/2023] [Indexed: 09/03/2023] Open
Abstract
Thyroid-associated ophthalmopathy (TAO) is an autoimmune disease involving the ocular tissues that may require strabismus surgery treatment. Presently, little is known about the impact of strabismus surgery on the quality of life of such patients. Consequently, the aim of the present study was to explore the effect of strabismus surgery on the quality of life of strabismus patients with quiescent TAO. This was a prospective case-series study. Strabismus patients with TAO who were admitted to the First Affiliated Hospital of Guangxi Medical University for strabismus surgery from October 2011 to April 2016 were included in this study. The included patients were asked to complete the Graves' ophthalmopathy quality of life questionnaire (GO-QOL) before strabismus surgery and 6 weeks after the surgery, respectively. Preoperative and postoperative GO-QOL scores were compared using the paired samples t-test. The correlation between strabismus surgery and the quality of life was analyzed using Spearman correlation analysis. In total, 23 patients, with a mean age of 49.04 years old, were included in the study. Compared to the preoperative GO-QOL scores, the postoperative scores of these patients for visual function (43.04 vs 73.50, P < .001) and psychosocial function (40.13 vs 72.93, P < .001) were both significantly increased. The greater the preoperative angle of misalignment of the eyes, the worse the psychosocial function (r = -0.433, P = .039). Strabismus surgery can significantly improve the quality of life of strabismus patients with quiescent TAO.
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Affiliation(s)
- Yihua Huang
- Department of Ophthalmology, Wuming School of Clinical Medicine of Guangxi Medical University, Wuming Hospital of Guangxi Medical University, Nanning, China
| | - Kaijun Li
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuqing Yan
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jianfeng He
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinmao Chen
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Tran L, Klainguti G, Hoeckele N, Kaeser PF. Torsional strabismus and vertical rectus muscle surgery in thyroid eye disease. J Fr Ophtalmol 2023; 46:49-56. [PMID: 36496294 DOI: 10.1016/j.jfo.2022.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/21/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the torsional component in patients with vertical strabismus due to thyroid eye disease (TED) and its course after vertical rectus muscle surgery. PATIENTS AND METHODS Retrospective chart review of patients undergoing vertical strabismus surgery for TED between 1998 and 2017, having undergone pre- and postoperative Harms tangent screen examination. RESULTS Forty patients (27 women) were identified. A torsional component was present in all patients. Thirty-three patients had a mean excyclotorsion of 4.5° in primary position, increasing to 8.2° in upgaze, associated with restricted elevation. Inferior rectus muscle recession (n=29) reduced the excyclotorsion in all cases. A 4.4° mean incyclotorsion was present in primary position in 7 cases, increasing to 7.1° in downgaze. Superior rectus muscle recession reduced the incyclotorsion in 5/6 cases. The torsional surgical dose-effect relationship was correlated with the amount of preoperative torsion. The field of binocular single vision improved from 6.5% preoperatively to 71.1% after surgery. CONCLUSIONS Ocular torsion is common in vertical strabismus secondary to TED and is significantly improved by vertical rectus muscle surgery alone. Surgery should be planned according to vertical deviation and motility limitation, and vertical rectus muscles surgery should be considered the first line of treatment, with selective oblique muscle surgery as a second-line option, which was unnecessary in our series.
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Affiliation(s)
- L Tran
- Hôpital ophtalmique Jules-Gonin, service d'ophtalmologie de l'université de Lausanne, 15, avenue de France, 1004 Lausanne, Switzerland
| | - G Klainguti
- Hôpital ophtalmique Jules-Gonin, service d'ophtalmologie de l'université de Lausanne, 15, avenue de France, 1004 Lausanne, Switzerland
| | - N Hoeckele
- Hôpital ophtalmique Jules-Gonin, service d'ophtalmologie de l'université de Lausanne, 15, avenue de France, 1004 Lausanne, Switzerland
| | - P-F Kaeser
- Hôpital ophtalmique Jules-Gonin, service d'ophtalmologie de l'université de Lausanne, 15, avenue de France, 1004 Lausanne, Switzerland.
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Eckstein A, Oeverhaus M, Dekowski D, Stöhr M, Merckel-Timmer E, Saeed P, Jellema HM. Primary and secondary superior rectus recessions to correct vertical deviations in Graves' orbitopathy patients. Acta Ophthalmol 2021; 99:850-860. [PMID: 33576183 DOI: 10.1111/aos.14796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/22/2021] [Indexed: 11/27/2022]
Abstract
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,Δ ) 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 3.2Δ reduction/mm recession in Group 1 (Spearman correlation r = 0.75, p < 0.0001) and 3.3Δ /mm in Group 2 (n.s.) and 4Δ /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 3Δ 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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Affiliation(s)
- Anja Eckstein
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Michael Oeverhaus
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Dirk Dekowski
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Mareile Stöhr
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Elly Merckel-Timmer
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Peerooz Saeed
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Hinke-Marijke Jellema
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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De-Moraes SLC, Pereira RDS, Afonso AMDP, Mattos RP, Ribeiro da Silva J, Santos RG, Calasans-Maia MD. A prospective study of resolution of post-traumatic orbital complications using PRECLUDE® MVP: A randomized controlled trial. Ann Med Surg (Lond) 2021; 61:139-144. [PMID: 33456773 PMCID: PMC7797472 DOI: 10.1016/j.amsu.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022] Open
Abstract
Orbital fractures alone represent 10% up to 25% of all facial fractures, but when they are associated with other fractures of the middle-third of the face, their incidence can increase up to 55%. This study aimed to identify whether the size of the orbital defect based on the classification by Jaquiéry et al. influenced the resolution of post-traumatic complications after orbital wall reconstruction using PRECLUDE®MVP alone or in combination with a titanium mesh or autogenous bone graft. Thirty-five orbits were categorized into four groups on the basis of the size of the defect and the operative techniques: group 1 contained 16 Jaquiéry class I orbits treated only with PRECLUDE®MVP; group 2 included eight class II orbits treated with PRECLUDE®MVP along with autogenous bone graft harvested from the calvaria or a titanium mesh; group 3 included five class III orbits and group 4 included six class IV orbits that were treated the same way as those in group 2. Spearman correlation showed that the use PRECLUDE®MVP didn't improve the post traumatic complications for big orbital defects due to the three-dimensional anatomical changes that occurred by neurologic lesions and lipolysis of the orbital contents.
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Affiliation(s)
| | | | | | - Ricardo Pereira Mattos
- Clinic for Cranio-Maxillofacial & Reconstructive Surgery, Hospital São Francisco, Rio de Janeiro, Brazil
| | | | - Roberto Gomes Santos
- Clinic for Cranio-Maxillofacial & Reconstructive Surgery, Hospital São Francisco, Rio de Janeiro, Brazil
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Vaidya A, Kakizaki H, Takahashi Y. Changes in horizontal strabismus after inferior rectus muscle recession with or without nasal transposition in thyroid eye disease: A retrospective, observational study. PLoS One 2020; 15:e0240019. [PMID: 33002097 PMCID: PMC7529222 DOI: 10.1371/journal.pone.0240019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/18/2020] [Indexed: 11/18/2022] Open
Abstract
Since the inferior rectus muscle (IRM) is a secondary adductor, it is expected to commonly observe esotropia in thyroid-associated inferior rectus myopathy, but this can be improved after the IRM recession. However, variable outcomes regarding the changes in horizontal strabismus after IRM recession ± IRM nasal transposition have been encountered in patients with thyroid eye disease (TED). We, therefore, examined the changes in 62 patients with TED in this retrospective, observational, comparative study. The patients were classified into 3 groups based on the results of postoperative changes in horizontal strabismus: Groups A (reduced esotropia), B (unchanged esotropia), and C (increased esotropia). Consequently, Groups A, B, and C included 23 (38.7%), 11 (17.7%), and 27 (43.5%) patients, respectively. In the multivariate linear regression analysis, the angle of preoperative esotropia (P < 0.001) and the amount of IRM nasal transposition (P = 0.049) were significant predictors of postoperative changes in horizontal strabismus. The results of our study will be helpful to ophthalmologists for formulating an effective preoperative surgical plan.
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Affiliation(s)
- Aric Vaidya
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
- * E-mail:
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Arnoldi K, Reynolds JD. Unmasking Bilateral Inferior Rectus Restriction in Thyroid Eye Disease: Using Degree of Cyclotropia. ACTA ACUST UNITED AC 2017; 65:81-6. [DOI: 10.3368/aoj.65.1.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Kyle Arnoldi
- Ross Eye Institute, University at Buffalo, Buffalo, New York
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Jellema HM, Saeed P, Mombaerts I, Dolman PJ, Garrity J, Kazim M, Dhrami-Gavazi E, Lyons C, Nieuwkerk P, Mourits MP. Objective and subjective outcomes of strabismus surgery in Graves' orbitopathy: a prospective multicentre study. Acta Ophthalmol 2017; 95:386-391. [PMID: 28133945 DOI: 10.1111/aos.13367] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/18/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the change and interrelationship of the field of binocular single vision (BSV) and the quality of life (QoL), tested with two different tools, after one or two strabismus surgeries in patients with Graves' orbitopathy (GO). METHODS Prospectively, consecutive patients with GO who were scheduled for their first strabismus surgery were recruited from five centres specialized in the treatment of GO. One week preoperatively and 3 months after the last operation, a full ophthalmic and orthoptic examination was performed. Change in field of BSV, GO-QoL and thyroid eye disease-QoL (TED-QoL) was recorded. RESULTS A total of 59 met all the eligibility criteria of whom 15 underwent two strabismus operations. The median (interquartile range) preoperative score of the field of BSV was 0 (0-0), which improved to 73 (53-85) after the correction(s) (p < 0.001). After the first surgery, a significant higher score of the field of BSV was found in the patients who underwent one operation (76; 60-86) compared with those who underwent two 0 (0-63) operations (p < 0.001). After the second surgery, this score increased to 62 (40-76; p = 0.05). A moderate correlation was found between the score of the field of BSV and the GO-QoL visual functioning (VF) questionnaires (r = 0.485; p < 0.001). Both the GO-QoL and TED-QoL for VF and appearance (AP) showed significantly higher scores after the treatment (p < 0.001). CONCLUSION 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.
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Affiliation(s)
| | - Peerooz Saeed
- Department of Ophthalmology; University of Amsterdam; Amsterdam The Netherlands
| | - Ilse Mombaerts
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - Peter J. Dolman
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver British Columbia Canada
| | - Jim Garrity
- Department of Ophthalmology; Mayo Clinic; Rochester New York USA
| | - Mike Kazim
- Department of Ophthalmology; Columbia University; College of Physicians and Surgeons; New York New York USA
| | - Elona Dhrami-Gavazi
- Department of Ophthalmology; Columbia University; College of Physicians and Surgeons; New York New York USA
| | - Christopher Lyons
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver British Columbia Canada
| | - Pythia Nieuwkerk
- Department of Medical Psychology; University of Amsterdam; Amsterdam The Netherlands
| | - Maarten P. Mourits
- Department of Ophthalmology; University of Amsterdam; Amsterdam The Netherlands
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Barker L, Mackenzie K, Adams GGW, Hancox J. Long-term Surgical Outcomes for Vertical Deviations in Thyroid Eye Disease. Strabismus 2017; 25:67-72. [DOI: 10.1080/09273972.2017.1318151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Takahashi Y, Kitaguchi Y, Nakakura S, Mito H, Kimura A, Kakizaki H. Correction of Excyclotropia by Surgery on the Inferior Rectus Muscle in Patients with Thyroid Eye Disease: A Retrospective, Observational Study. PLoS One 2016; 11:e0159562. [PMID: 27434022 PMCID: PMC4951151 DOI: 10.1371/journal.pone.0159562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/04/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose To examine the characteristics of excyclotropia correction through surgery on the inferior rectus muscle in patients with thyroid eye disease. Methods This was a retrospective, observational study at a single institution. We reviewed 36 patients who had undergone unilateral inferior rectus muscle recession, with or without nasal inferior rectus muscle transposition. The following factors were investigated as possibly influencing excyclotropia correction: inferior rectus muscle thickness, degree of adipose change in the inferior rectus muscle, smoking status, history of orbital radiotherapy, and the amount of inferior rectus muscle recession. Using T1-weighted coronal magnetic resonance imaging, we measured the cross-sectional area of the inferior rectus muscle at its largest point, as well as the bright-signal area of the inferior rectus muscle, which reflects intermuscular adipose change. We then calculated the percentage internal bright-signal area at the point of the largest inferior rectus muscle cross-sectional area. The history of orbital radiotherapy was graded using a binary system. We evaluated correlations among excyclotropia correction, the amount of nasal inferior rectus muscle transposition, and the possible influencing factors listed, using stepwise multiple regression analyses. Results The multiple regression model demonstrated a significant relationship among excyclotropia correction, amount of nasal inferior rectus muscle transposition, and the amount of inferior rectus muscle recession (YCORRECTION = 8.546XTENDON WIDTH + 0.405XRECESSION− 0.908; r = 0.844; adjusted r2 = 0.695; P < 0.001). Conclusions Excyclotropia correction was correlated with the amount of nasal inferior rectus muscle transposition and the amount of inferior rectus muscle recession, but not with the other factors. The regression model presented in this study will enable us to determine more precisely the amount of nasal inferior rectus muscle transposition in patients with excyclotropia of various angles.
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Affiliation(s)
- Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Yoshiyuki Kitaguchi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Hidenori Mito
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
- Ide Eye Hospital, Yamagata, Japan
| | - Akiko Kimura
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
- * E-mail:
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Jellema HM, Braaksma-Besselink Y, Limpens J, von Arx G, Wiersinga WM, Mourits MP. Proposal of success criteria for strabismus surgery in patients with Graves' orbitopathy based on a systematic literature review. Acta Ophthalmol 2015; 93:601-9. [PMID: 25876459 DOI: 10.1111/aos.12717] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/18/2015] [Indexed: 11/29/2022]
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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Affiliation(s)
| | | | | | - Georg von Arx
- ADMEDICO Augenzentrum; Interdisziplinäres Zentrum für Endokrine Orbitopathie; Olten Switzerland
| | - Wilmar M. Wiersinga
- Department of Endocrinology and Metabolism; Academic Medical Center; Amsterdam The Netherlands
| | - Maarten P. Mourits
- Department of Ophthalmology; Academic Medical Center; Amsterdam The Netherlands
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13
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Inferior oblique recession in thyroid-related orbitopathy. J AAPOS 2015; 19:274-7. [PMID: 26059675 DOI: 10.1016/j.jaapos.2015.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/19/2015] [Accepted: 01/20/2015] [Indexed: 11/20/2022]
Abstract
Thyroid-related orbitopathy is a form of orbital inflammation associated with thyroid dysfunction, developing in many patients with Graves disease. Fibrosis of the inferior rectus muscle can lead to restricted elevation and vertical ocular misalignment, which may be improved by recessing this muscle. In some patients, vertical misalignment persists after surgical weakening of one or more vertical rectus muscles. In this case series, unilateral inferior oblique recession as a secondary procedure after inferior rectus recession reduced hypertropia in primary gaze from 9(Δ) ± 3(Δ) to 1.3(Δ) ± 1.5(Δ) (mean ± standard deviation) and largest hypertropia in side gaze from 18.3 ± 2.1(Δ) to 3.3(Δ) ± 1.5(Δ). Postoperatively, all 3 patients were diplopia free in primary and downgaze.
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Jellema HM, Saeed P, Groenveld L, Kloos R, Mourits MP. Outcome of inferior and superior rectus recession in Graves' orbitopathy patients. Orbit 2015; 34:84-91. [PMID: 25836060 DOI: 10.3109/01676830.2015.1014501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To evaluate the surgical effect of unilateral inferior rectus recession (IR-group) with or without a recession of contralateral superior rectus (IR-SR-group) on squint angle and motility restrictions in Graves' Orbitopathy (GO) patients. DESIGN Retrospective case series. MATERIALS AND METHODS Primary outcome parameters were the changes of squint angle 3 months and 6-12 months postoperatively. As in a previous study, success was defined as a postoperative vertical squint angle of ≤3° in primary position and on downgaze. Secondary outcome parameters were the influence of surgery on duction range and influence of muscle size on dose-effect response. RESULTS Fifty-six patients were included in the study; 31 patients in the IR-group and 25 patients in the IR-SR-group. The amount of (fixed suture) recession ranged from 2 mm to 7 mm. Vertical deviations in primary position changed from 8.0° [95% CI 6.6-9.7°] to 1.0° [95% CI -0.4-6.5°] in the IR-group and from 17.0° [95% CI 15.7-20.0°] to 1.5° [95% CI 0.8-2.9°] in the IR-SR-group. The success rate was 74% in the IR-group and 64% in the IR-SR-group. Elevation significantly improved in both groups (IR-group p = 0.007; IR-SR- group p = 0.000). The volume of vertical rectus muscles as assessed on CT-scans did not influence the dose-effect response. CONCLUSIONS The highest success rate and highest reduction of depression was found in the IR-group. The total duction range remained stable after strabismus surgery (IR-group) or improved (IR-SR-group). Both squint angle and cyclodeviation remained stable during long time follow-up (6-12 months after surgery).
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Roussat B, Kilani W, de Preobrajensky N, Berche M, Du Pasquier L, Paques M. Surgical management of dysthyroid diplopia with preservation of the anterior ciliary vascularization: review of ten cases. J Fr Ophtalmol 2015; 38:118-25. [PMID: 25596774 DOI: 10.1016/j.jfo.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/28/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE During the surgical correction of dysthyroid diplopia, the risk of ischemia by transection of the anterior ciliary arteries is well-known. In order to avoid this, we modified the classical surgical technique: (1) through the preservation of the vascular pedicles during muscle recession and (2) if necessary, through a plication (instead of a resection) of the ipsilateral antagonist muscle. The objective to be achieved is thus the resolution of the diplopia without ischemic complications. SUBJECTS AND METHODS We report a prospective series of 10 patients with dysthyroid ophthalmopathy, causing strabismic diplopia, all operated on by the same surgeon (BR) after at least 12 months of euthyroidism. Data collection included: history of previous decompressive surgery, surgical procedure, and oculomotor status before and after surgery. RESULTS Ten patients (8 females), aged 51 to 74 years (mean age, 58.00 ± 7.62 years), were collected between 2008 and 2012. All patients had one or more vascular risk factors (diabetes, smoking, obesity, high blood pressure). With a follow-up from 16 to 67 months (mean ± SD 27.7 months ± 14.87), surgical outcomes were excellent: diplopia was cured in all cases, with recovery of stereoscopic vision. We had no operative or postoperative complications. CONCLUSIONS The technique of preservation of the anterior ciliary vascularization, which is particularly justified for these fragile patients, is compatible with moderate muscle recessions. For larger deviations, in which a larger recession might increase the proptosis, it is possible to add a plication of the ipsilateral antagonist. This surgical technique made possible the suppression of the diplopia in all cases.
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Affiliation(s)
- B Roussat
- Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
| | - W Kilani
- Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - N de Preobrajensky
- Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - M Berche
- Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - L Du Pasquier
- Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - M Paques
- Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
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Jellema HM, Saeed P, Braaksma-Besselink Y, Schuit A, Kloos R, Mourits MP. Unilateral and bilateral medial rectus recession in Graves’ Orbitopathy patients. Strabismus 2014; 22:182-7. [DOI: 10.3109/09273972.2014.962749] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jellema HM, Merckel-Timmer E, Kloos R, Saeed P, Mourits MP. Quality of life improves after strabismus surgery in patients with Graves' orbitopathy. Eur J Endocrinol 2014; 170:785-9. [PMID: 24493116 DOI: 10.1530/eje-13-0973] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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 46.3±24.2 before surgery and 65.7±30.5 after surgery (P=0.009). The GO-QoL score for appearance changed from 60.6±25.9 to 69.5±24.2 (P=0.005). After surgery, the field of BSV increased from 24.3±34.8 to 68.5±36.0 points (P=0.000). A weak correlation was found between the field of BSV and the visual functioning score after surgery (r=0.417; P=0.034). CRR was found in 20 (71%) patients. Those with a CRR showed a larger field of BSV (P=0.002) and better GO-QoL scores (P=0.008). 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.
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Affiliation(s)
- Hinke Marijke Jellema
- Department of Ophthalmology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Kassem IS, Miller MT, Archer SM. One Year of Pediatric Ophthalmology and Strabismus Research in Review. Asia Pac J Ophthalmol (Phila) 2013; 2:388-400. [PMID: 26107151 PMCID: PMC6839686 DOI: 10.1097/apo.0000000000000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To highlight recent advances in amblyopia and strabismus. DESIGN Literature review. METHODS A literature search of articles published in the English language was performed in PubMed or MEDLINE between May 2012 and April 2013 using the terms amblyopia or strabismus. Articles deemed relevant were selected. RESULTS The review highlights articles that increase our understanding of strabismus and amblyopia as well as newer treatment strategies. CONCLUSIONS The review highlights some new information and possible future advances in amblyopia and strabismus.
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Affiliation(s)
- Iris S Kassem
- From the *University of Illinois at Chicago Eye and Ear Infirmary, Chicago, IL; and †Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI
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Strabismus Surgery in Thyroid-Related Eye Disease: Strategic Decision Making. CURRENT OPHTHALMOLOGY REPORTS 2013. [DOI: 10.1007/s40135-013-0027-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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