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Y. Inoue, A. Kouzaki, T. Maeda; Muscle Adhesion and Diplopia in Dysthyroid Myopathy . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1946.
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Purpose:A major focus of this study is to evaluate the restricted changes of extraocular muscle (EOM) movement in dysthyroid ophthalmopathy (DO). Concerning the pathogenesis of diplopia, fibrotic and inelastic EOM has been reported, however on the adjustable EOM surgery, a cicatrical adhesion to the surface of the affected muscle is observed on its sheath and in some cases the surrounding connective tissue adheres to the affected muscles. Methods:The material consists of 75 cases of diplopia; 35 esotropia, 40 hypotropia; 33 male, 52 female, mean age 53.3 years old, age distribution 25 to 77 years. Patterns of cicatrical adhesion are classified into regular and irregular types and the measurement of the distance of EOM between the top of the adhesion and the place of insertion is estimated by using a scale in the surgery. The severity of eye movement is determined by the field of fixation at the goldman perimeter. Results:In the cases of esotropia almost all patterns of adhesion were regular type, but on hypotropia, various types were observed, which did not correspond to the severity of the diplopia. The severity of diplopia depended on the distance of measured muscle which is free from cicatrical tissue, it was statistically significant (p<0.05). Conclusions:Patterns of the cicatrical adhesion is not related to the severity of diplopia. Positive forced duction test changed to negative response after the removal of the cicatrical tissue. The severity of the diplopia is directly related to the length of EOM that is not affected by cicatrical tissue. We believe that it is better to remove the cicatrical tissue on the sheath of affected EOM in order to get the smooth movement of EOM after surgery.
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