Strabismus surgery in topical anaesthesia with intraoperative suture adjustment in Graves' orbitopathy

To report the results of strabismus surgery in a series of patients with Graves' orbitopathy (GO), using topical anaesthesia with intraoperative suture adjustment.

All first-time strabismus surgeries in patients with GO in our department during the years 2014-2021 (n = 45) were assessed retrospectively. Among these, 31% came from outside our health region due to increased complexity of the strabismus condition. Orbital decompression surgery had been carried out in 58% of the patients prior to strabismus surgery. Patients with less than 2 months of follow-up were excluded from the study. Median follow-up time was 22 months.

Among the total patient material, 37 (82%) could be operated with topical anaesthesia with intraoperative suture adjustment. There were no cases with triggering of the oculo-cardiac reflex during the procedure. Among the 36 patients operated with topical anaesthesia and follow-up time ≥2 months, 11 (31%) needed further surgery. Late overcorrection after recession of the inferior rectus was seen in 19%. At the last control examination, 32 (89%) were diplopia-free in primary and down-gaze position, either with or without weak prisms.

Strabismus surgery in topical anaesthesia with intraoperative suture adjustment appears to be a suitable and safe procedure in most patients with GO, including difficult and complex cases. The patients should be informed about the possibility of additional surgery and/or post-operative need for prism glasses.