Purchase this article with an account.
N. Mirza-George, G. Binenbaum, N. J. Volpe; Modern Management of Hypertropia in Thyroid Eye Disease With Adjustable Sutures. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1131.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Restrictive vertical strabismus due to thyroid eye disease (TED) is challenging to correct. We report the clinical outcomes of a management approach employing adjustable sutures.
Retrospective case series . 41 subjects with TED and hypertropia underwent unilateral or bilateral adjustable-suture inferior rectus recession (IRRec) by one surgeon (NJV). Surgery variably included non-adjustable superior rectus recession (SRRec) on the hypertropic eye. Intraoperative forced-ductions determined number of vertical muscles recessed. Post-adjustment goal was orthotropia or undercorrection in primary gaze without hyperdeviation in downgaze ipsilateral to IRRec. Outcomes were vertical alignment within 5pd of orthotropia, diplopia, reoperation, and need for prisms.
Forty subjects had preoperative diplopia. Median preoperative primary-position deviation was 12pd (range 4-50). 21(66%) subjects had unilateral IRRec; 14(34%) bilateral. 17(41%) subjects had SRRec. 8 patients were adjusted same-day, 33 next-day. On long-term follow-up (mean 41wks), no subjects had diplopia, although two subjects required re-operation (4.9%/95%CI 0.6-16.5) and 13(32%) required prism (9/13 were <5pd). 8 of these 15 subjects had overcorrections. 33(80%) subjects had successful vertical alignment after one surgery, of which 21 were orthotropic. In multivariate regression, day of adjustment, number of vertical muscles recessed, and previous decompression did not affect outcomes.
Previous TED studies report a reoperation rate of 17-45%. Our findings suggest that using adjustable-sutures, operating on multiple muscles if indicated, and planning for postoperative IR weakening can reduce this rate. While 1/3 of patients required prisms, long-term deviations were small. We conclude that TED-associated hypertropia can be successfully managed with unilateral and bilateral adjustable-suture IRRec, with or without supplemental SRRec.
This PDF is available to Subscribers Only