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Large Inferior Rectus Recession without Lower Eyelid Retraction in Thyroid Eye Disease.

Birsen Gokyigit1, Asli Inal2, Ceren Gurez2

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Summary

A novel surgical technique for thyroid eye disease effectively reduces vertical strabismus and improves gaze limitation. This method avoids lower eyelid retraction, offering a safer alternative for patients with inferior rectus fibrosis.

Keywords:
Bovine pericardiumthyroid eye diseasevertical strabismus

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Area of Science:

  • Ophthalmology
  • Endocrinology
  • Surgical Innovation

Background:

  • Thyroid eye disease (TED) frequently causes restrictive strabismus, particularly vertical deviation due to inferior rectus (IR) muscle fibrosis.
  • This can lead to significant limitations in eye movement, impacting patients' quality of life.
  • Existing surgical techniques may cause complications like lower eyelid retraction.

Purpose of the Study:

  • To introduce and evaluate a new surgical technique for managing vertical strabismus in TED patients.
  • To assess the efficacy of this technique in improving gaze limitations and reducing vertical deviation.
  • To determine if the new technique avoids the complication of lower eyelid retraction.

Main Methods:

  • A bovine pericardium graft (Tutopatch®) was used to lengthen the IR tendon in six TED patients.
  • The graft was inserted between the IR tendon's distal end and the muscle fibers using non-absorbable sutures.
  • Mid-term results were analyzed for vertical deviation and up-gaze limitation.

Main Results:

  • The procedure was performed on six patients (six eyes) with a mean preoperative vertical deviation of 19.5 prism diopters (PD) and severe up-gaze limitation (-4.1).
  • Postoperatively, the mean vertical deviation decreased to 3.5 PD, and up-gaze limitation improved to -1.3.
  • No instances of lower eyelid retraction were reported.

Conclusions:

  • The introduced surgical technique is effective in correcting vertical deviation and improving gaze limitations in TED patients.
  • This method offers a favorable outcome without inducing lower eyelid complications.
  • The use of bovine pericardium appears to be a safe and effective adjunct for IR lengthening in TED.