Topical anaesthesia in strabismus surgery for Graves’ orbitopathy: a comparative study of 111 patients

Abstract

Purpose To evaluate the tolerability and usability of topical anaesthesia in single rectus muscle recession for strabismus caused by Graves’ orbitopathy (GO). To compare the perioperative pain score and surgical outcome between GO patients and non‐GO patients. Methods A retrospective comparative study of consecutive single rectus muscle recession performed under topical anaesthesia was carried out. All patients scheduled for one‐stage single rectus muscle recession under topical anaesthesia were included. Numerical visual analogue pain score scale (NVAS) points, rates of motor success (horizontal deviation < 8 prism diopters (PD) and vertical deviation ≤ 6 PD) and sensory success (no diplopia without prisms), complications and postoperative adjustment frequencies were compared between GO and non‐GO patients. Results A total of 111 patients were included. The mean perioperative pain scores were 2.3 (SD ± 1.3) in GO and 1.6 (SD ± 1.1) in non‐GO patients (p = 0.06 adjusted for gender). The postoperative mean alignments in GO and non‐GO patients were 2 versus 3 PD horizontally and 1 versus 1 PD vertically respectively. Both motor and sensory success rates were 98% in GO patients and 94% versus 93% in non‐GO patients. Adjustments as a second procedure the day after surgery was performed in 10% of the GO patients and 15% of the non‐GO patients. The oculocardiac reflex was not triggered in any of the GO patients. Conclusion Topical anaesthesia in single muscle recession for GO is safe, well‐tolerated and gives comparable surgical outcomes to those achieved in non‐GO patients.

Nationwide Incidence of Thyroid Eye Disease and Cumulative Incidence of Strabismus and Surgical Interventions in Denmark

“…Targeted biological therapies are expected to have a broader indication in the future . Strabismus surgery is performed in the chronic inactive and stable stage when a patient’s symptoms, such as diplopia, cannot be treated with other modalities …”

“…5,6 Strabismus surgery is performed in the chronic inactive and stable stage when a patient's symptoms, such as diplopia, cannot be treated with other modalities. 7 Decompression surgery is performed either as an acute procedure when vision is threatened because of optic nerve compression or as a rehabilitation procedure in the chronic phase and preferably before strabismus surgery. In Denmark, international guidelines were implemented and treatment centralized to 6 locations so that timely and necessary TED treatment is available to reduce long-term sequelae.…”