Surgical Treatment of Diplopia in Patients with Endocrine Orbitopathy
Authors:
L. Pražáková; P. Rezek
Authors‘ workplace:
Oční oddělení Oblastní nemocnice Kolín, a. s.
primář MUDr. Pavel Rezek, CSc.
Published in:
Čes. a slov. Oftal., 71, 2015, No. 5, p. 248-252
Category:
Original Article
Overview
Purpose:
To evaluate the results of surgical treatment of diplopia in patients with endocrine orbitopathy.
Materials and methods:
Retrospective evaluation of the results of patients with diplopia associated with endocrine orbitopathy operation at the Department of Ophthalmology in Kolin Hospital during the period 2008–2013. All the patients included in the study group were exposed to retroposition of inferior rectus and moreover, 11 of them underwent retroposition of medial rectus. Five patients were not taken into consideration at all during the statistical analysis because of other surgical operations of extraocular muscles, which were indispensable for proper removal of diplopia in primary gaze position.
All the patients underwent overall eye and orthoptic examination as well as objectification of the eye movement disorder and diplopia by Hess test preoperatively and 1 month after surgery. Deviation of the eye with worse mobility was chosen for assessment. Subjective perception of the diplopia became another criterion.
Results:
There were 72 patients without diplopia in primary gaze position. In 4 patients correction with prismatic glasses (3 pdpt) was necessary for residual vertical deviation. Thirty six patients reached functional binocular vision half a year after surgery proved by ortoptic assessment. Compensatory head position disappeared in all patients in this group.
Conclusion:
The treatment of endocrine orbitopathy should be complex. Proper indication and timing of the surgery is mandatory for the successful results.
Key words:
endocrine orbitopathy, diplopia, surgery of strabismus
Sources
1. Bahn, R. S., Garrity, J. A., Bartley, G. B. et al.: Diagnosis evaluation of Graves ophtalmopathy. Endocrinology Metabolic Clinic NA, 17; 1988: 527–545.
2. Boergen, K., P.: Ophthalmological diagnosis in autoimmune orbitopathy. Exp Clin Endocrinology Diabetes, 97 (2/3); 1991: 235–242.
3. Brunová, J.: Diagnostika a terapie poruch funkce štítné žlázy. Medicína pro praxi, 5 (6); 2008: s. 254–257.
4. Byrne, F. S., Gendron, E. K., Glaser, J. S. et al.: Diameter of normal extraocular recti muscle with echography. Am J Ophthalmol, 112 (6); 1991: s. 706–713.
5. Divišová, G. a kol.: Strabismus. Avicenum, Praha, 1979: 295 s.
6. Dvořák, J., Váňa, S., Veselý, J., et al.: Multidisciplinární přístup k léčbě endokrinní orbitopatie. Rozhl Chir, 72 (6); 1993: s. 272–273.
7. Fells, P., Kousoulides, L., Pappa, A.: Extraocular muscle problems in thyroid eye disease. Eye, 8; 1994: s. 497–505.
8. Gorman, C. A.: The presentation and management of endokrine oftalmology. Clinic Endokrinol, 7; 1979: 67–75.
9. Helveston, E. M.: Operations atlas of Strabismus. Mosby, Saint Louis 1973: s. 523–525.
10. Hudson, H. L., Levin, L., Feldon, S. E.: Graves exophthalmos unrelated to extraocular muscle enlargement. Superior rectus muscle inflammation may induce venous obstruction. Ophthalmology, 98 (10); 1991: 1495–1499.
11. Karhanová, M., Kalitová, J., Vláčil, O. et al.: Konzervativní možnosti řešení diplopie u pacientů s endokrinní orbitopatií. Čes a Slov Oftal, 69 (5), 2013: 220–224.
12. Karhanová, M., Kovář, R., Fryšák, Z. et al.: Postižení okohybných svalů u pacientů s endokrinní orbitopatií. Čes a Slov Oftal, 70 (2); 2014: 66–71.
13. Karhanová, M., Vláčil, O., Šín, M. et al.: Srovnání metody nastavitelných versus fixních stehů při operaci strabismu u pacientů s endokrinní orbitopatií. Čes a Slov Oftal, 68 (5); 2012: 207–213.
14. Kazim, M., Trojek, S., Moore, S.: Treatment of acute Graves orbitopathy. Ophthalmology, 98 (9); 1991: s. 1443–1448.
15. Murakami, Y., Kanamoto, T., Tsuboi, T. et al.: Evaluation of extraocular muscle enlargement in dysthyroid ophthalmopathy. Nihon Ganka Gakkai Zasshi, 104 (1); 2000: s. 34–38.
16. Němec, J. a kol.: Diagnostika chorob štítné žlázy. Thomayerova sbírka č. 508, Praha, Avicenum, 1988: 173 s.
17. Němec, J. a kol.: Léčba nemocí štítné žlázy. Thomayerova sbírka č. 514, Praha, Avicenum, 199: 155 s.
18. Novák, Z., Hrdá, P., Matucha, P.: Prediktivní faktory rozvoje známek tyreoidální orbitopatie u pacientů po léčbě radiojodem nebo totální tyreoidektomií, Vnitřní lékařství, 51 (6); 2005: s. 650–657.
19. Otradovec, J.: Chirurgické výkony u endokrinní orbitopatie. Čs Oftal, 39 (4); 1983: s. 111–114.
20. Rezek, P.: Endokrinní orbitopatie – chirurgická léčba. Kandidátská disertační práce, Praha, 2001: 85 s.
21. Rodahl, E., Seland, J., Olofsson, J. et al.: Surgical treatment of endocrine ophthalmopathy, Tidsskr Nor Laegeforen, 119 (12); 1999: s. 1737–1742.
22. Váňa, S., Rezek, P., Lukáš, J. et al.: Operativní léčba endokrinní orbitopatie. Indikace, metody, výsledky. Vnitř Lék, 38 (9); 1992: s. 897–902.
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OphthalmologyArticle was published in
Czech and Slovak Ophthalmology
2015 Issue 5
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