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Stephen M. Huddleston, Natalie C. Kerr, James C. Fleming; Proptosis and Orbital Decompression Prior to Strabismus Surgery in Patients with Graves Ophthalmopathy: Influence on Postoperative Shift in Eye Alignment. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6348. doi: https://doi.org/.
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When performing horizontal or vertical rectus muscle recessions in patients with thyroid eye disease (TED), outcomes are less predictable than in patients without TED, often due to overcorrection shifts that occur in the postoperative period. In this study, we hoped to determine whether overcorrection shifts after inferior or medial rectus recession correlated with prior decompression or presence of proptosis at the time of strabismus surgery.
A retrospective chart review of adult patients with TED who had undergone a single medial or inferior rectus recession with an adjustable suture technique was performed. Overcorrection shifts (> 5 prism diopters) that occurred between the time of suture adjustment and the 2-month follow-up visit were examined. Statistics performed included descriptive statistics, Anderson-Darling tests for normality, odds ratios, and Fisher’s test. Results were considered statistically significant for P <0.05.
Thirty-four patients who had TED and inferior rectus recession, and 13 patients who had thyroid eye disease and medial rectus recession met inclusion criteria for study. Twenty-nine of these patients had orbital decompression surgery prior to their eye muscle surgery. Orbital decompression was not associated with late overcorrection shift when evaluated using a box and whiskers plot and the Anderson-Darling test for normality (P=0.25 for patients with prior orbital decompression and P=1.8 x 10-6 for patients without prior orbital decompression). Seven of 30 patients with proptosis had a significant overcorrection following either inferior or medial rectus recession. This resulted in an odds ratio of 1.319 with a 95% CI of .29-5.993.
After unilateral muscle recession for hypotropia or esotropia, overcorrection shifts did not show an association with prior orbital decompression or the presence of proptosis at the time of strabismus surgery. Thus, alteration of the surgical plan to avoid late overcorrections in patients with TED solely on the basis of proptosis or prior orbital decompression does not seem warranted.
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