The Characteristics and Surgical Outcomes of Medial Rectus Recessions in Graves’ Ophthalmopathy

Abstract

<h4>PURPOSE</h4> <p>To evaluate the clinical characteristics and surgical outcomes of medial rectus (MR) recessions in patients with Graves’ ophthalmopathy.</p> <h4>PATIENTS AND METHODS</h4> <p>The clinical records of 32 patients with Graves’ ophthalmopathy who underwent MR recessions with adjustable sutures for restrictive esotropia were reviewed. The clinical characteristics of patients, the size of the esodeviations, the limitations of ductions, the surgical doses, and observed responses to surgery were recorded and analyzed. Main outcome measures included the ratio of predicted to observed correction for MR recessions, improvement in ductions, and restoration of binocular status.</p> <h4>RESULTS</h4> <p>The mean age of the 32 patients (20 women, 12 men) at surgery was 54.1 ± 11.4 years. The mean duration of thyroid eye disease was 4.3 ± 5.4 years (range, 1 to 24 years). The ratios of predicted to observed correction for esodeviations at distance and near, respectively, were 2.21 ± 1.24 and 2.16 ± 1.81 at the time of adjustment and 1.61 ± 0.37 and 1.84 ± 0.90 at final follow-up. The limitation of abduction improved from -2.3 ± 1.3 to -0.75 ± 0.98. Binocular single vision was achieved in 73% of patients, and a further 10% of patients were able to fuse with prisms. A history of decompression was present in 75% of cases. Patients with a history of decompression had more restriction in abduction (-2.49 vs -1.78, <i>P</i> = .061), more frequently required bilateral surgery (75% vs 62.5%), and had a higher ratio of predicted to observed correction (1.71 ± 0.37 vs 1.37 ± 0.28, <i>P</i> = .043).</p> <h4>CONCLUSIONS</h4> <p>Patients with Graves’ ophthalmopathy who undergo MR recession for restrictive esotropia are prone to undercorrection. A history of decompression is associated with a less favorable clinical outcome. Augmented surgery, adjustable sutures, or both are recommended for improved surgical outcomes.</p> <p><cite>J Pediatr Ophthalmol Strabismus</cite> 2007;44:93-100.</p> <h4>AUTHORS</h4> <p>The authors were from the Massachusetts Eye & Ear Infirmary, Boston, Massachusetts. Dr. Mocan is currently from Hacettepe University, Ankara, Turkey. Dr. Ament is currently from Boston University School of Medicine, Boston, Massachusetts. Dr. Azar is currently from the University of Illinois at Chicago, Chicago, Illinois.</p> <p>Originally submitted October 8, 2005.</p> <p>Accepted for publication December 22, 2005.</p> <p>Address correspondence to Nathalie Azar, MD, Massachusetts Eye & Ear Infirmary, Pediatric Ophthalmology & Strabismus Service, Floor 1, 243 Charles Street, Boston, MA 02114.</p> <p>The authors have no industry relationships to disclose.</p> <p>The audience is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage.</p> <p>The material presented at or in any Vindico Medical Education continuing medical education activity does not necessarily reflect the views and opinions of Vindico Medical Education or SLACK Incorporated. Neither Vindico Medical Education or SLACK Incorporated, nor the faculty endorse or recommend any techniques, commercial products, or manufacturers. The faculty/author may discuss the use of materials and/or products that have not yet been approved by the U.S. Food and Drug Administration. All readers and continuing education participants should verify all information before treating patients or utilizing any product.</p>

The management of large-angle esotropia in Graves ophthalmopathy with combined medial rectus recession and lateral rectus resection

“…It is commonly taught that smaller medial rectus recessions are sufficient to resolve larger deviations in restrictive strabismus than typically recommended for nonrestrictive strabismus. However, it has been our experience and that of others 8,15,16 in Graves ophthalmopathy that even large medial rectus recession alone resulted in undercorrection more frequently than overcorrection in patients with large-angle esotropia. Years ago, this observation led Dyer to experiment with combining recessions with resections in initial surgery to reduce the total number of operations, which is the approach we advocate here.…”

Korrektur horizontaler Schielwinkel nach Dekompressionsoperation bei Patienten mit endokriner Orbitopathie – Vergleich von Sehnenverlängerung und einfacher Rücklagerung des M. rectus medialis

“…Die Ergebnisse zeigen im Vergleich zu Kohorten von Patienten ohne vorangegangene Dekompression, dass bei Operationen nach Dekompression eine deutlich höhere Variabilität der Dosis-Wirkungs-Beziehung vorliegt [33 -36]. Dies wurde auch bereits von Mocan et al (2007) und Jellema et al (2014) gezeigt [29,30]. Beide Studien zeigten einen etwas höheren Effekt (1,4°/mm), allerdings war der Anteil der Patienten nach Dekompression in beiden nur 75 bzw.…”

The role of rectus muscle myectomy in the management of large-angle strabismus for Graves’ ophthalmopathy

“…[4][5][6] It is well accepted that the surgical management for large-angle deviation is much more challenging and is associated with higher failures rate. [3][4][5]7,8 Extensively fibrotic and severely restricted extraocular muscles limit the postoperative predictability. For large-angle strabismus, especially with single-rectus muscle restriction without much of the contralateral antagonist muscle involvement, surgical approaches have mainly been multiple-muscle recession with adjustable sutures.…”