Surgical Management of Extraocular Muscle Dysfunction in Patients with GO

Eckstein, Anja; Esser, Joachim

doi:10.1007/978-1-4939-2534-6_21

Cited by 9 publications

(4 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Squint surgery aims firstly to restore fusion in primary position avoiding diplopia in down gaze and then to correct residual incomitances [122,123]. This is achieved by means of extension of extraocular rectus muscle recessions and retroequatorial myopexias.…”

Section: Recommendationsmentioning

confidence: 99%

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

et al. 2016

Self Cite

View full text Add to dashboard Cite

Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.

show abstract

Section: Recommendationsmentioning

confidence: 99%

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…Abb. Unsere eigenen sehr guten Erfahrungen mit der "deviation correction"-Technik bei der Rectus-inferior-Rücklagerung (also Festlegung der OP-Strecke präoperativ anhand der gemessenen Schielstellung) mit dem Ziel einer Unterdosierung für den ersten präoperativen Tag führt wesentlich seltener zu Übereffekten [2,19,20]. Deshalb ist eine M.-rectus-inferior-Rücklagerung bei großen Schielwinkeln immer als Ersteingriff zu bevorzugen, da durch diesen Eingriff die Hebung deutlich gebessert wird und sich die Seitendifferenz in den vertikalen monokularen Exkursionen signifikant bessert [21].…”

Section: Effekt Auf Das Feld Des Binokularen Einfachsehensunclassified

Prinzip Gegenparese: M.-obliquus-inferior-Rücklagerung bei Patienten mit endokriner Orbitopathie

Eckstein¹,

Raczynski²,

Dekowski³

et al. 2015

Klin Monatsbl Augenheilkd

View full text Add to dashboard Cite

Inferior oblique muscle recession can be very successfully performed on the contralateral eye in patients with mild inferior rectus muscle fibrosis. Surgery at the contralateral yoke muscle prevents the risk of overeffect with resulting diplopia in downgaze, which could occur if small distance recession had been performed at the inferior rectus muscle. An overeffect in relation to inferior oblique recession will only cause diplopia in upgaze, which is much less troublesome in daily routine.

show abstract

“…Restorative eye surgery should be performed in the inactive stage of GO, in order to prevent further deterioration post-surgery. The specifics of these surgeries are not the focus of this review but a number of good chapters and reviews are readily available [108][109][110][111].…”

Section: Orbital Surgerymentioning

confidence: 99%

Current and Future Treatments for Graves’ Disease and Graves’ Ophthalmopathy

Kotwal

Stan

2018

Horm Metab Res

View full text Add to dashboard Cite

The course and pathogenesis of Graves’ disease and Graves’ ophthalmopathy are interdependent, influencing each other’s therapeutic choices. Multiple factors including geographic location, access to medical services, patient and physician preferences influence the management of these conditions. Graves’ disease is classically managed with one of three treatment options – antithyroid drugs, radioactive iodine, and thyroidectomy. In recent years, there has been a shift towards antithyroid drugs, including long term therapy with these agents, given the advantage of avoiding hypothyroidism and the apparent safety of this approach. In addition, new therapies are (slowly) emerging, focusing on immunomodulation. Technological advances are opening doors to non-pharmaceutical interventions that aim to deal with both structural thyroid abnormalities as well as biochemical abnormalities of hyperthyroidism. Graves’ ophthalmopathy management is guided by its activity and severity status, with treatment options including smoking cessation, control of hyperthyroidism, local eye measures, glucocorticoids, selenium, orbital radiotherapy, and surgery. In addition to these established treatment choices, new immunotherapy-based approaches are being tested. Some of them (tocilizumab and teprotumumab) are very promising but further evaluation is needed before we can establish their role in clinical care. Agents identified as beneficial in Graves’ disease management will likely be tested in Graves’ ophthalmopathy as well. In the coming years, our main clinical responsibility will be to find the proper balance between the benefits and potential risks of these incoming therapies, and to identify the subgroups of patients where this ratio is most likely to favor a safe and successful therapeutic outcome.

show abstract

Surgical Management of Extraocular Muscle Dysfunction in Patients with GO

Cited by 9 publications

References 36 publications

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

Prinzip Gegenparese: M.-obliquus-inferior-Rücklagerung bei Patienten mit endokriner Orbitopathie

Current and Future Treatments for Graves’ Disease and Graves’ Ophthalmopathy

Contact Info

Product

Resources

About