Purchase this article with an account.
Stacy Scofield-Kaplan, Kristen Dunbar, Gregory Stein, Michael Kazim; Improvement in Eccentric and Primary gaze ocular alignment in Thyroid Eye Disease-Strabismus Surgery by the addition of Tenon recession. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5159.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effect of the addition of Tenon recession to horizontal strabismus surgery in patients with thyroid eye disease.
This is an Institutional Review Board-approved retrospective analysis of patients with thyroid eye disease (TED) undergoing horizontal strabismus surgery for esotropia. The study included all patients from 2007 to 2015 operated on by a single surgeon (MK) at Columbia University Medical Center. Surgical success was defined as the ability to fuse at both near and distance either without prismatic correction or with less than 10 PD of correction. Measurements of ocular alignment were also made in eccentric fields of gaze.
Twenty-eight patients with TED and restrictive horizontal strabismus underwent unilateral or bilateral medial rectus recession to relieve diplopia. Overall the success rate was 86% and a re-operation rate of 10.7%. The improvement in horizontal deviation in all five cardinal positions of gaze was statistically significant (P<0.001), but the change in vertical deviation in the five cardinal positions of gaze was not statistically significant (Figures 1-2). There was coincidental postoperative change in vertical deviation, which was not proportional to the preoperative horizontal deviation or the amount of horizontal recession.
The addition of Tenon recession to TED-horizontal strabismus surgery led to statistically significant improvement in ocular alignment in both primary, and eccentric gaze. This is the first study of TED-strabismus surgery to analyze the post-operative results in positions outside of primary and reading gaze. Due to the preoperative incomitance of ocular deviations in this subset of patients, it has been routine to expect persistent postoperative eccentric misalignment. We postulate that the release of scar tissue by the addition of Tenon recession contributes to these improvements. Additionally, the postoperative change in vertical deviation was unpredictable suggesting that horizontal and vertical muscle surgery in TED should be preformed serially to achieve more reliable outcomes.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only