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A.J. Dal Canto, S. Crowe, J.D. Perry, E. Traboulsi; Adjustable Globe and Muscle Technique for Strabismus Repair in Thyroid Eye Disease . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2963.
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Purpose: The purpose of this study is to review the outcomes of extraocular muscle (EOM) surgery in patients with thyroid eye disease (TED) using a technique in which the recessed muscle insertion is determined intraoperatively using adjustable globe and muscle positions. Methods: 23 patients (5M:18F) aged 49.75 (20–71) yrs underwent strabismus surgery using an adjustable globe and muscle technique to treat diplopia. Diplopia followed orbital decompression in 7 patients, worsened after decompression in 3 patients, and occurred independently of decompression in 13. Six patients had ET (av. 27.3 pd); 7 had HT (av. 25.0 pd); 9 had a combination of ET and HT (av. 20.8 pd ET, 21.1 pd HT) and 1 had a combination of XT and HT (XT 10, HT 6). Ocular deviations were stable for an average of 6.5 months in 11 patients, and for more than 1 year in 12. Recession of BMR only was performed in 4 patients, IR only in 5 patients, BIR and BMR in 5 patients, combinations of uni– or bilateral IR and MR in 5 patients, RSR and LIR in 1 patient, RSR only in 1 patient, RIR, LSR, and RMR in 1 patient, and RLR and RIR in 1 patient. Results: Twenty of the 23 patients had excellent outcomes (no diplopia in primary and reading positions, without the use of prisms), and 3 had good outcomes (no diplopia in primary and reading positions with use of small prisms). Two patients underwent second surgeries to obtain their final outcomes (1 with excellent results and 1 with good results). Ten patients had less than 6 months of follow–up. Six patients kept their 6 month follow up visit, and 7 patients were seen 1 year or more after surgery. Linear regression did not show good correlation between the degree of strabismus and amount of recession required for eliminating diplopia (maximum R2 = 0.6697). Conclusions: The adjustable globe and muscle technique provides reliable and consistent superior ocular alignment and relief from diplopia in the majority of patients with strabismus from TED. This technique may be preferable to table nomograms since poor correlation was obtained between the degree of strabismus and amount of recession. This is likely secondary to changes in the EOM (ie fibrosis) secondary to TED.
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