Rectus Muscle Resection for Vertical Strabismus in Thyroid Eye Disease

Area of Science:

• Ophthalmology
• Oculoplastics
• Strabismus Surgery

Background:

• Thyroid eye disease (TED) management typically avoids rectus muscle resection due to risks of increased restriction or inflammation.
• However, significant vertical strabismus and diplopia in primary gaze may necessitate alternative surgical strategies beyond recession.

Purpose of the Study:

• To evaluate the surgical experience and outcomes of rectus muscle resection in patients with vertical strabismus associated with TED.
• To assess the efficacy and safety of this approach in eliminating diplopia.

Main Methods:

• Retrospective review of eight TED patients who underwent vertical rectus muscle resection for vertical diplopia.
• Surgical goals included eliminating diplopia in primary and reading positions.
• Vertical deviations were measured pre-operatively and post-operatively using prism alternate cover testing.

Main Results:

• Significant reduction in vertical deviation for both near and distance was observed post-surgery (p<0.05).
• 62.5% of patients achieved binocular single vision in primary and reading positions within four months.
• No recurrence of inflammation or increased muscle restriction was noted.

Conclusions:

• Vertical rectus muscle resection can be a safe and effective additional surgical option for managing vertical strabismus in TED patients.
• This technique may be considered when other surgical interventions have not fully resolved diplopia.