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Daniel Greninger, Pamela Berg, Eric Steele; Treatment of Esotropia from Thyroid Eye Disease by Lateral Rectus Resection. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5905. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the results of a controversial surgical approach for the primary treatment of large angle esotropia and for residual esotropia in patients with thyroid eye disease.
A retrospective chart review was performed for all patients undergoing strabismus surgery by a single surgeon from 2008-2012 after orbital decompression for thyroid eye disease. Patient characteristics, surgical technique, and pre/post-operative measurements of ocular alignment were recorded and analyzed.
Of 47 patients who had surgery to treat diplopia, 12 received lateral rectus resection, either as a primary procedure combined with medial rectus recession (n=6) or as a secondary procedure for residual esodeviation after prior medial rectus recession (n=6). In the 6 patients receiving primary resections, the mean preoperative esotropia was 55 PD (median 55, range 30-80) and mean postoperative esodeviation was 2 PD (median 0, range 0-8). In the 6 patients receiving secondary resections, the mean preoperative esotropia was 21 PD (median 20, range 12-50) and mean postoperative esodeviation was 4 PD (median 0, range 0-20). The mean follow up was 19.5 months (median 17, range 3-41). There were no cases of late overcorrection. Diplopia resolved in all cases after surgery.
Lateral rectus resection in combination with medial rectus recession can be effective as both a primary and secondary treatment for esotropia after orbital decompression in thyroid eye disease. The common practice of avoiding muscle resections in thyroid eye disease-related strabismus should be reconsidered.
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