Purchase this article with an account.
L. Minasyan, L. Zangwill, D. O. Kikkawa; Risk Factors Associated With Double Vision After Orbital Decompression in Patients With Thyroid-Related Orbitopathy (TRO). Invest. Ophthalmol. Vis. Sci. 2010;51(13):3920.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To identify risk factors associated with development of strabismus after orbital decompression in patients with thyroid eye disease.
This retrospective non-interventional case series included data from chart reviews of thyroid eye patients previously seen at UCSD between January of 1998 and July of 2009. Data obtained included demographics, slit lamp and orbital examination, external photography, radiographic images, treatment and subsequent clinical course. Inclusion criteria included patients who sought treatment at the study facilities for TRO. The subjects were categorized in 3 groups based on the ocular deviation status before and after the surgery: no change in ocular alignment, improvement (reduction of deviation), or worsening (either development of primary gaze strabismus or worsening of non-primary gaze deviation).
Results were obtained from 181 subjects (55 males and 126 females). The mean age was 49.4 with range of 14 to 86. 108 patients (59.7%) showed no change in strabismus after surgery; 13 (7.2%) showed improvement; and 60 (33.1%) showed worsening. There was no correlation with age (p=0.3957). However, more females (37.3%) than males (23.6%) had worsening (p=0.016) after decompression surgery. There was no significant correlation found between deviation status and use of systemic medications; however, the patients who were taking oral prednisone overall did worse than those that were not. Patients who had worsening had a larger reduction of proptosis, with mean of 5.67, compared to patients that had no change (mean 4.77) or had improvment (mean 5.03) (p=0.0078). Using Tukey-Kramer HSD test confirmed that the correlation of worsening strabismus and greater proptosis reduction is statistically significant. The type of decompression (one, two or three walls) was not shown to be significant.
Overall, female gender, greater proptosis reduction and history of oral steroid use are associated with worsening or development of strabismus. The association between the steroid use and the worsening of strabismus may be due to selection bias of more severe disease.
This PDF is available to Subscribers Only