Surgical management on restrictive strabismus of patients with thyroid associated ophthalmopathy

Objective To evaluate the outcomes of recession of extraocular muscles on restrictive strabismus of patients with thy- roid associated ophthalmopathy.Design Retrospective case series.Participants Fifteen thyroid associated ophthalmopathy(TAO)pa- tients with stationary restrictive strabismus caused by myopathy of one extraocular muscle of one eye.Methods Recession of the dis- eased extraocular muscles was applied.Before and after operation,the areas of binocular vision without diplopia on a acr perimeter mea- sured the movement distances of eyeball from the primary position to the restricted direction,the angles of strabismus in nine directions with synoptophore were measured in all patients.Main Outcome Measures The areas of binocular vision without diplopia,the move- ment distances of eyeball from the primary position to the restricted direction,and the absolute angles of strabismus in primary position and downward 15°direction when the restricted eye gazed target were compared before and after operation.Results Inferior rectus mus- cle recession were performed in nine eyes,superior rectus recession were performed in 4 eyes,and medial rectus recession in 2 eyes. The average areas of binocular vision without diplopia significantly increased from 23.99±19.39°before operation to 2115.72±527.10°after operation.The average movement distances of eyeball from the primary position to the restricted direction significantly increased from 1.53±0.97 mm before operation to 6.03±0.74 mm after operation.The average absolute angles of strabismus in primary position gazed by the restricted eyes significantly decreased from 22.37±6.63°before operation to 1.53±1.47°after operation.The average abso- lute angles of strabismus in downward 15°direction gazed by the restricted eyes significantly decreased from 15.67±11.53°before opera- tion to 2.17±1.90°after operation.Intraocular hypertention in 5 patients before operation decreased among normal range after operation. Compensatory head posture in all patients before operation disappeared after operation.Eyelid retraction was the main surgical compli- cation.Conclusion Recession of extraocular muscles can markdely eliminate diplopia and strabismus,improve eyeball motability. (Ophthalmol CHN,2007,16:414-417)