Incidence and treatment of diplopia after three-wall orbital decompression in Graves' ophthalmopathy

Abstract

The authors reviewed their experience in treating diplopia after orbital decompression in patients with thyroid orbitopathy. Orbital decompression was performed on 102 patients (34 men and 68 women) for either compressive optic neuropathy or disfiguring proptosis. Persistent postoperative diplopia in primary gaze was present in 53 eyes (52%) six months after orbital decompression. Ten patients (9.8%) with no preoperative diplopia developed diplopia in primary gaze after decompression. Among 43 patients with preoperative diplopia in primary gaze, 19 (18.6%) remained unchanged and 24 (23.5%) worsened considerably after decompression. Nine (17%) of 53 patients with postoperative diplopia obtained resolution of postoperative diplopia with prismatic lenses. The remaining 44 patients (83%) underwent adjustable extraocular muscle surgery with the use of viscoelastic substances to gain single vision in primary position. Thirty-one of these patients obtained stable resolution of diplopia in primary gaze after one surgical procedure. Ten of these patients required a second surgery on the oblique muscles six months after the first procedure to eliminate persistent torsional diplopia. Three of these patients required prismatic lenses for full resolution of diplopia after strabismus surgery. Orbital decompression of Graves' orbitopathy is associated with a high incidence of postoperative diplopia that can subsequently be successfully managed with strabismus surgery and prismatic lenses.—Michael D. Wagoner The authors reviewed their experience in treating diplopia after orbital decompression in patients with thyroid orbitopathy. Orbital decompression was performed on 102 patients (34 men and 68 women) for either compressive optic neuropathy or disfiguring proptosis. Persistent postoperative diplopia in primary gaze was present in 53 eyes (52%) six months after orbital decompression. Ten patients (9.8%) with no preoperative diplopia developed diplopia in primary gaze after decompression. Among 43 patients with preoperative diplopia in primary gaze, 19 (18.6%) remained unchanged and 24 (23.5%) worsened considerably after decompression. Nine (17%) of 53 patients with postoperative diplopia obtained resolution of postoperative diplopia with prismatic lenses. The remaining 44 patients (83%) underwent adjustable extraocular muscle surgery with the use of viscoelastic substances to gain single vision in primary position. Thirty-one of these patients obtained stable resolution of diplopia in primary gaze after one surgical procedure. Ten of these patients required a second surgery on the oblique muscles six months after the first procedure to eliminate persistent torsional diplopia. Three of these patients required prismatic lenses for full resolution of diplopia after strabismus surgery. Orbital decompression of Graves' orbitopathy is associated with a high incidence of postoperative diplopia that can subsequently be successfully managed with strabismus surgery and prismatic lenses.—Michael D. Wagoner