Standard Strabismus Surgery in Thyroid Ophthalmopathy

Abstract

Introduction: Techniques for the surgical treatment of thyroid-related strabismus are varied and include nonadjustable (standard) and adjustable sutures. This study reports results from one clinical practice utilizing standard strabismus procedures for treatment of thyroid ophthalmopathy. Methods: The charts of 32 consecutive patients who underwent surgery in the past 5 years for restrictive strabismus secondary to thyroid ophthalmopathy were retrospectively reviewed. All surgeries were performed by reattachment of the muscle to the globe, allowing for no postoperative adjustment (standard technique). Results: All 32 patients had preoperative diplopia and restricted motility. Twenty-two patients wore prisms prior to surgery. Of the 32 patients who underwent surgery, 9 required a second operation. After reoperation five patients (12%) continued to have diplopia; however, four of these patients were able to achieve single binocular vision with prism. Only one patient was unable to achieve single binocular vision with or without prism. Twenty-two (54%) had full motility after surgery. After one surgery, 25 of 32 patients (78%) were satisfied with the visual results of surgery. This increased to 31 patients (97%) after reoperation. Discussion: There is disagreement as to which technique (adjustable versus standard) has a better surgical outcome. This was not a comparative study, but meant to present the results of one clinical practice with standard techniques. Strabismus surgery with adjustable sutures can potentially be uncomfortable and produce late overcorrection. In our study, strabismus surgery by standard techniques provided excellent postoperative results with a 97% satisfaction rate. Conclusion: The results of the study indicate that strabismus surgery for restrictive thyroid ophthalmopathy using standard techniques can provide excellent results and patient satisfaction.