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. 2018 Nov 23;18(1):305.
doi: 10.1186/s12886-018-0974-0.

Intraoperative relaxed muscle positioning technique results in a tertiary Center for Thyroid Orbitopathy Related Strabismus

Ahmet Murat Sarici  1 , Burak Mergen  2 , Velittin Oguz  2 , Cezmi Dogan  2
Affiliations

Intraoperative relaxed muscle positioning technique results in a tertiary Center for Thyroid Orbitopathy Related Strabismus

Ahmet Murat Sarici et al. BMC Ophthalmol. .

Abstract

Background: Previous techniques resulted with low rates of successful fusion after the surgeries and high necessity of additional surgeries in the treatment of thyroid orbitopathy related strabismus. In this study, reviewing the results of our patients who had surgical correction with relaxed muscle positioning technique due to thyroid orbitopathy related strabismus to evaluate the effectiveness of the surgery was aimed.

Methods: The medical records of 8 patients who had surgical correction with intraoperative relaxed muscle positioning (IRMP) technique were studied retrospectively. The extent of strabismus was determined with prism cover test both at near and distance. The extent of recession was determined by marking the natural place of the released tendon during the primary position. The muscle then sutured to the globe at this precise point.

Results: Seven eyes (87.5%) of 8 patients had orthophoria after the surgery and they reported no diplopia in primary and reading gaze. The mean age of the patients was 51 ± 8.8 years. The mean follow-up time was 32.7 ± 18.5 months. Three patients had inferior rectus recession (IRR), 3 had bilateral medial rectus recession (MRR), 1 had only right MRR and 1 had combined MRR with IRR during the surgical correction of the strabismus. The mean amount of recession for IR was 7.5 ± 1.34 mm and it was 6.75 ± 0.95 mm for the MR muscles. The mean prism diopter before the surgery was 37.8 ± 23.3 and it was 0 after surgery except only one of the patients who had > 60 prism diopter (PD) left esotropia (ET) before surgery and had 30 PD left ET after surgery (3.3 ± 9.4).

Conclusion: IRMP technique is a unique option for the surgical correction of thyroid orbitopathy related strabismus. By showing a dramatic increase in the quality of life of the patients, our surgical results are promising despite limited number of patients.

Keywords: Intraoperative relaxed muscle positioning; Restrictive strabismus; Thyroid orbitopathy.

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Conflict of interest statement

Authors’ information

Not applicable.

Ethics approval and consent to participate

Approval from the local ethical committee (Cerrahpasa Ethics Committee) was received. Informed consent was obtained from the patients for the participation in the study.

Consent for publication

Additional consent was obtained from the patients whose preoperative and postoperative photos were used in the manuscript.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Intraoperative relaxed muscle positioning of the inferior (a) and medial (b) rectus muscle . After releasing the tendon from its insertion, the precise point is marked for the optimal effect. Then the muscle is sutured onto this precise point
Fig. 2
Fig. 2
Preoperative (a), early postoperative (b) and late postoperative (c) photos of a patient for whom medial and inferior rectus muscle recession was performed with the intraoperative relaxed muscle positioning technique
Fig. 3
Fig. 3
Preoperative photo of a patient with horizontal strabismus (a). Late postoperative photo after bilateral MRR surgery (b)
Fig. 4
Fig. 4
Preoperative (a) and postoperative (b) photos of a patient with vertical strabismus for whom IRR was performed
See this image and copyright information in PMC

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