Purchase this article with an account.
Sylvia Yoo, Stacy Pineles, Robert Goldberg, Federico Velez; Rectus Muscle Resection in Graves Ophthalmopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1766.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Rectus muscle resections are generally avoided in patients with Graves ophthalmopathy due to concern for worsening inflammation or restriction. In rare cases, such as patients with large angle strabismus and unilateral decreased vision who refuse bilateral surgery, or in patients with residual diplopia, in whom maximal recession surgery has already been performed, rectus muscle resection may be considered. We report eight patients with Graves who underwent rectus muscle resections without significant complications.
The records of 1,694 patients with Graves ophthalmopathy were reviewed. Data from subjects who had undergone rectus muscle resections were collected.
Eight patients aged 25 years to 70 years were identified. Six of the patients were female. In primary gaze, three patients had only a horizontal deviation and the remaining five had both horizontal and vertical deviations. Horizontal deviations ranged 8-42 prism diopters, and vertical deviations ranged 2-14 prism diopters. Post-operatively, 4 patients were orthotropic with no diplopia; 3 patients were improved, but still had diplopia in at least one direction of gaze; and one patient had worsening of the deviation. One patient developed temporary superficial punctate keratitis; none developed atypical conjunctival injection or inflammation.
Of the eight patients with Graves who underwent rectus muscle resections, seven had improvement of their diplopia. None of the patients developed atypical inflammation. In rare circumstances, rectus muscle resection may be considered for patients with Graves ophthalmopathy if other surgical options have been exhausted. Patients should still be counseled on the risks of worsening inflammation or restriction.
This PDF is available to Subscribers Only