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Esotropia, ductions worsened in patients undergoing decompression surgery
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Decompression surgery yielded worsening of both esotropia and ductions, according to a study.
The retrospective cohort study aimed to describe post-decompression changes that might affect staging of surgical rehabilitation of thyroid orbitopathy. The analysis included 169 patients who underwent the procedure between 1983 and 2001.
Over an average follow-up of 1.2 years, esotropia increased by an average of 8.1 ∆D (P < .01). However, no significant alteration was reported for exotropia and vertical deviations. A decrease in ductions of more than 5° in at least one meridian occurred in 68.1% of patients.
No change occurred in upper eyelid retraction. A 50% improvement was reported for lower eyelid retraction, from 1.44 mm to 0.7 mm (P < .01).
Other findings indicated an improvement in exophthalmometry, from 23.5 mm to 19.7 mm (P < .01). The investigators observed a correlation between this result and the number of walls removed (P < .01).
“This investigation provides further evidence for changes in multiple orbital parameters with decompression,” the researchers said. “The implications of these findings apply to both surgical staging and outcome counseling.” – by Rob Volansky
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Scott E. Olitsky, MD
Traditional teaching regarding the surgical rehabilitation of patients with thyroid orbitopathy states that strabismus surgery should be performed following orbital decompression surgery due to the possibility of altering the strabismus. The study by Rootman et al appears to support this approach. In their study, almost 20% of patients with strabismus before decompression surgery demonstrated a change in their alignment after surgery. While there was no significant change in patients with exotropia or vertical strabismus, it should be pointed out that this result was an average. Therefore, this finding should not be interpreted to suggest that these patients could have strabismus surgery at the same time they undergo decompression with predictable results. While the authors also report that most patients had a decrease in motility after surgery, this decrease tended to be small and may not be clinically relevant.
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