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Impressum
Results of three wall orbital decompression and following eye muscle surgery in patients with severe thyroid associated ophthalmopathy
1Eckstein A., 1Esser M., 1Fischer M., 2Krüger C., 2Mohr C. H., 1Steuhl K. P., 1Esser J.
1Department of Ophthalmology, 2Department of Oral and Maxillofacial Surgery, Essen University Clinics, D-45122 Essen, Germany
Introduction: The development of the ocular motiliy after three
wall orbital decompression (in patients with compressive neuropathy due
to TAO) and after the following eye muscle surgery is presented.
Patients and methods: Between 1997 and 2000, 27 patients with compressive
TAO underwent orbital decompression (three walls). The following parameters
were analysed before and after decompression and after eye muscle surgery:
proptosis, monocular excursions, angle of squint in primary position,
field of binocular single vision.
Results: Before decompression 14/27 patients had a horizontal and
15/27 a vertical strabism. Elevation was reduced to 21°(±10°),
abduction to32°(±12°) and adduction to 37°(±10°).
After decompression 25/27 patients had a horizontal and 17/27 a vertical
deviation. The increase of the horizontal deviation was 15° (mean
value) and of the vertical deviation 0.8°. The elevation of the bulbus
was unchanged while the abduction was worsened to 20°(±10°)
and the adduction to 34°(±9°). After the first eye muscle
operation (recession of the medial rectus 18x bilaterally/7x unilaterally;
recession of the inferior rectus 10x unilaterally/1x bilaterally) binocular
single vision could be established in 17 patients. In 10 patients further
surgery was necessary. At the end of the treatment only 4 patients remained
with a persistent angle of squint (1° - 4°), which could be corrected
by prisms. The mean reduction of strabismus per mm recession was 1.3°/mm
(min 0.2°/mm; max 2.5°/mm, medial rectus muscles).
Discussion: Abduction is severly worsend after removal of the medial
orbital wall, which was necessary to decompress the optic nerve. All other
ductions are only minimally changed. With medial rectus recessions strabism
can successfully be managed in primary position. The effect of the recessions
has a high variability. Thus, in some cases eye muscle surgery is required
more than one time.