Ocular motility problems after orbital decompression for dysthyroid ophthalmopathy

Area of Science:

• Ophthalmology
• Endocrinology

Background:

• Dysthyroid (Graves') ophthalmopathy often requires orbital decompression surgery.
• Postoperative ocular motility issues, including diplopia and strabismus, are common concerns.

Purpose of the Study:

• To analyze ocular motility problems in patients after orbital decompression for Graves' ophthalmopathy.
• To identify factors associated with the development of postoperative diplopia and strabismus.

Main Methods:

• Retrospective analysis of 50 consecutive patients undergoing orbital decompression.
• Evaluation of globe retrodisplacement, surgical approach, and indication for decompression.
• Assessment of preoperative and postoperative ocular alignment, versions, and ductions.

Main Results:

• No significant correlation found between globe retrodisplacement, surgical approach, or indication and postoperative diplopia.
• Patients with vision-threatening ophthalmopathy had a higher (non-significant) risk of developing postoperative strabismus.
• Preoperative strabismus changes predicted increased esotropia and/or restrictive hypertropia postoperatively.
• 11 of 32 orthotropic patients developed new primary position strabismus; only 5 patients with normal preoperative versions/ductions remained normal postoperatively.

Conclusions:

• Orbital decompression for Graves' ophthalmopathy can lead to new-onset or worsened strabismus.
• Preoperative strabismus is a key indicator for potential postoperative alignment issues.
• Careful preoperative assessment of ocular motility is crucial for managing patient expectations and surgical planning.