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Akiko Kimura; Long-term results of extraocular muscle surgery for thyroid ophthalmopathy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5616.
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© ARVO (1962-2015); The Authors (2016-present)
To report surgical results for strabismus in patients with thyroid ophthalmopathy.
Material and methods:One hundred and thirty-six patients complaining of diplopia due to thyroid ophthalmopathy had extraocular muscle surgery at Hyogo College of Medicine Hospital from 2012 to 2015. Seventy-five of these patients (male: 30, female: 45) with the follow-up period of over a year were included in this study. Cases involving intraoperative use of botulinum toxin were excluded. The mean age was 60.1 years (range: 31-86) and the mean follow-up duration was 29.4 months (range:12.0-65.3). Initial surgical procedure was to recess the affected muscles. Horizontal transposition of vertical rectus muscles was additionally performed in cases with cyclodeviation. Postoperative eye position, the rate of elimination of diplopia, stereopsis, and field of binocular single vision (BSV) were investigated. The field of BSV was scored by a functioning scoring method reported by Sullivan, et al (Ophthalmology 99, 1992).
Results:Preoperatively, vertical deviation was found in 40 cases (53.3%), esotropia in 6 cases (8.0%), and horizontal deviation with vertical deviation in 29 cases (38.7%). After surgery, vertical deviation improved from 10.8±5.9°to 1.9±2.3° and excyclodeviation and esotropia improved from 8.5±3.6°to 1.5±1.8°and from 21.5±23.3PD to 0.3±4.1PD , respectively. Postoperative eye position remained stable for periods from 3 weeks to over a year. Seventy-two cases (96.0%) were free of diplopia in the primary position after the first series of operations. Only 10 cases showed normal stereopsis preoperatively, but 43 cases showed this after surgery. The scores of stereopsis improved significantly after surgery (p＜0.0001). The BSV score was 9.7 points preoperatively, 39.9 points on the day after surgery, 59 points 3 weeks after, 68.4 points 3 months after and 64.3 points 1 year after. The BSV scores rose significantly between the day after surgery and 3 weeks after, and kept stable between 3 weeks after and over a year.
ConclusionStrabismus surgery for thyroid ophthalmopathy was effective in eliminating diplopia due to improvements in vertical deviation and cyclodeviation. This resulted in the significant improvement of stereopsis and the expansion of the field of BSV.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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