Initial Postoperative Alignment in Strabismus Related to Thyroid Eye Disease.

Area of Science:

• Ophthalmology
• Surgical Outcomes
• Thyroid Eye Disease

Background:

• Thyroid eye disease (TED) frequently causes strabismus, leading to diplopia and impacting quality of life.
• Strabismus surgery is a common intervention for managing diplopia in TED patients.

Purpose of the Study:

• To evaluate the impact of initial postoperative angle of deviation on surgical success rates in patients with thyroid eye disease undergoing strabismus surgery.
• To determine optimal initial correction strategies for hypotropia and esotropia in TED.

Main Methods:

• Retrospective review of 78 patients who underwent strabismus surgery for TED.
• Patients categorized into overcorrection (>5 PD), full correction, or undercorrection (>5 PD) groups based on day 1 postoperative deviation.
• Success defined as absence of vertical (<5 PD) and horizontal (<10 PD) diplopia at primary gaze.

Main Results:

• Higher success rates observed in undercorrection (80.0% hypotropia, 84.6% esotropia) and full correction (66.7% hypotropia, 83.3% esotropia) groups compared to overcorrection (35.7% hypotropia, 37.5% esotropia).
• Reoperation rates were 29.4% for hypotropia and 25.9% for esotropia.
• Initial postoperative deviation significantly influenced surgical outcomes (P=.02 for both hypotropia and esotropia).

Conclusions:

• Intended minimal undercorrection or full correction in the early postoperative period is associated with improved surgical success rates for hypotropia and esotropia in TED patients.
• Avoiding overcorrection is crucial for optimizing surgical outcomes in TED-related strabismus.
• These findings support adjusting initial surgical targets to enhance functional vision and reduce reoperation rates.