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Hachemi Nezzar, Romain Bordas, Anne Sabadel, Selwa Al Hazzaa, Frederic Chiambaretta, GTA: groupe thyroïde auvergne; Eye cyclotorsion after deep lateral orbital wall decompression (DLOWD) in Grave’s orbitopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4101.
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Ocular Motility disturbances after orbital decompression surgery in patient with Grave’s orbitopathy are common. Several surgical options are possible and the challenge for the surgeon is to choose a tailored surgery to each patient. Medial wall and floor decompression surgeries associate up to 30% diplopia after surgery.DLOWD seems to give less evelopment or worsening diplopia. Vertical and horizontal eye deviations are fully studied but few publications about cyclodeviation. The purpose of this study is to evaluate cyclodeviation after DLOWD in thyroid related orbitopathy (TRO) patient, using Harms Chart
We performed a retrospective non randomized clinical analysis in TRO patients who were undergo DLOWD from June 2011 to June 2013. Thirteen TRO patients (10 females ) with were included, six patient underwent bilateral surgery. The average follow up was 15 month ,range (6 to 29). Ophthalmology and orthoptic examinations were performed before and after surgery (one, two, six and repeated every six month) for both eye by using Harms Chart evaluation. This methods evaluate the eye deviation and cyclotorsion in the nine gaze positions. patients with previous strabismus surgery were excluded. Statistical analysis: Mann-Whitney nonparametric tests were performed with GraphPad Prism 5.02 software to determine the significance of differences between samples. P values of ≤0.05 were regarded as significant
After surgery the mean decrease of the exophthalmos was 3.5 mm (+/- 1.5mm). Before surgery 9 patients (69%) had a diplopia in primary gaze position.Harms chart shows excyclotropia in 8 diplopic patients and one of them an incyclotropia. Mean amplitude of excyclodeviation in primary gaze position was 10° (range 5° to 20°). Excyclodeviation in down gaze position (reading position) was statistically similar to primary gaze position. After surgery (2 month) the mean amplitude of the exyclodeviation was 9° (range 3° to 18°). After surgery there is no significant modification (P<0.9) of the excyclodeviation
Previous studies show that DLOWD has no effect on eye horizontal and vertical deviation. Others authors demonstrated that medial orbital wall decompression increase the outcome of diplopia due to horizontal and vertical eye deviation and risk of incyclotorsion. Ours study is the first demonstrating the no effect on eye cyclodeviation during lateral orbital wall decompression
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