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Torsional diplopia after orbital decompression and strabismus surgery
Massimiliano Serafino1, Paolo Fogagnolo, Rupal H Trivedi
1Paediatric Ophthalmology and Strabismus Unit, Department of Surgery, San Paolo Hospital, University of Milano, Italy.
European Journal of Ophthalmology
|November 3, 2009
Summary
Inferior oblique muscle disinsertion during orbital decompression surgery for thyroid eye disease increases the risk of postoperative torsional diplopia. Preserving or reattaching this muscle may prevent this complication.
Area of Science:
- Ophthalmology
- Oculoplastics
- Strabismus Surgery
Background:
- Thyroid-related orbitopathy often necessitates orbital decompression surgery (DS).
- Diplopia is a common complication following DS, requiring further management.
- The role of specific muscle manipulation during DS in diplopia development needs clarification.
Purpose of the Study:
- To investigate the occurrence and characteristics of diplopia after orbital decompression surgery.
- To assess the impact of inferior oblique (IO) muscle disinsertion during DS on postoperative diplopia, particularly torsional diplopia (TD).
Main Methods:
- Retrospective analysis of 45 patients undergoing DS, with a subgroup of 10 undergoing IO muscle disinsertion.
- Diplopia assessment pre- and post-DS using standard clinical tests.
- Quantification of strabismus using alternate prism-and-cover test and double Maddox rod test for TD.
Main Results:
- Strabismus surgery effectively treated horizontal and vertical diplopia, though some required prism glasses.
- Torsional diplopia (TD) was not resolved by strabismus surgery.
- All patients with prior IO disinsertion during DS developed TD postoperatively, compared to 8/30 without IO disinsertion (p<0.001).
- Overall, 40% of the DS cohort developed TD.
Conclusions:
- Inferior oblique (IO) muscle disinsertion during orbital decompression surgery (DS) is associated with a significantly higher risk of developing postoperative torsional diplopia (TD).
- Sparing or reattaching the IO muscle during DS may be crucial in preventing the development of untreatable TD.
- Careful surgical technique during DS is recommended to minimize the risk of induced TD.
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