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Observational Study
. 2022 Nov 10:13:1030422.
doi: 10.3389/fendo.2022.1030422. eCollection 2022.

Long-term follow-up of surgical treatment of thyroid-associated orbitopathy restrictive strabismus

Gustavo Savino  1 , Roberta Mattei  1 , Annabella Salerni  1 , Claudia Fossataro  1 , Pia Clara Pafundi  2
Affiliations
Observational Study

Long-term follow-up of surgical treatment of thyroid-associated orbitopathy restrictive strabismus

Gustavo Savino et al. Front Endocrinol (Lausanne). .

Abstract

Objective: Thyroid-associated orbitopathy (TAO) is the most frequent cause of extraocular muscle enlargement, with consecutive restrictive strabismus. The main muscles involved are inferior and medial rectus, resulting in horizontal esotropia and/or vertical strabismus. Surgery may either establish or improve binocular single vision. The aim of the present study is to describe long-term follow-up of patients who underwent horizontal or vertical TAO strabismus surgery.

Methods: This observational retrospective study included 29 patients suffering from either vertical or horizontal TAO strabismus and diplopia, of whom 11 underwent bilateral medial recti muscle recession (Group A) and 18 underwent unilateral inferior rectus muscle recession (Group B). The endpoint of the study was the assessment of changes in deviation angle and diplopia across four time points (baseline, 7 days, 6 months, and 24 months) in each group.

Results: In Group A, the horizontal deviation angle significantly decreased 7 days after intervention (p < 0.001), without modifications overtime. In Group B, both deviation angles in primary and down-gaze position significantly decreased from baseline, both 7 days after surgery (p < 0.001) and at 6 months (p = 0.040). An overcorrection, with an inversion of vertical deviation angle, was observed across the different time points.

Conclusions: Horizontal TAO strabismus correction leads to significant improvements of deviation angle and diplopia, with a stable undercorrection overtime. Inferior rectus recession leads to more unstable results, with a trend towards overcorrection limited to the first 6 months after surgery.

Keywords: diplopia; muscle recession; restrictive strabismus treatment; strabismus in TAO surgery; thyroid associated orbitopathy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Deviation angle at four time points. Deviation angle modifications at 7 days, 6 months, and 24 months, with respect to pre-surgery in Group A and Group B, respectively. P.P., Primary Position; D.P., Down-Gaze Position.
Figure 2
Figure 2
MRD2. MRD2 changes 6 months after surgery in Group B. MRD2: Margin Reflex Distance - 2.
Figure 3
Figure 3
Trend of diplopia at four time points. Changes in diplopia from baseline (pre-surgery), up to 24 months’ follow-up in the two groups (Group A on the left and Group B in the middle and on the right). P.P.: Primary Position; D.P. Down-Gaze Position; MRD2.
See this image and copyright information in PMC

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