Evaluation of Prognostic Factors and Outcomes of Single-Stage Adjustable Strabismus Surgery in Thyroid Eye Disease

ABSTRACT

PURPOSE: To evaluate the prognostic factors that contribute to favorable surgical outcomes of single-stage adjustable strabismus surgery in thyroid eye disease. METHODS: Retrospective review of clinical case notes were done of all patients who had surgical treatment for strabismus related to thyroid eye disease under the care of a single hospital between January 2005 and December 2012 (n = 30). Factors that possibly influenced the outcome were statistically analyzed for significance. "Successful" surgical outcome was defined as patients whose residual deviation was within 8 prism diopters and free from diplopia in the primary position on postoperative 1 year. RESULTS: Mean preoperative vertical deviation was 17.5 prism diopters (PD) and horizontal deviation was 20.3 PD. Mean follow-up time was 12.4 months. Twenty-four patients (80.0%) had successful surgical results. Four patients (13.3%) needed further surgery due to recurrence of previous strabismus and two patients (6.7%) needed prism glasses due to remaining strabismus. Previous history of proptosis (p = 0.02), optic neuropathy (p = 0.01), intravenous (IV) steroid pulse therapy (p = 0.02), number of times of IV steroid pulse therapy (p = 0.01), and orbital decompression surgery (p = 0.03) were different between success and failure groups. CONCLUSIONS: Single-stage adjustable strabismus surgery under topical anesthesia showed a success rate of 80% for strabismus patients with thyroid eye disease. Patients who previously had proptosis, optic neuropathy, IV steroid pulse therapy, and orbital decompression surgery significantly showed unsuccessful results after strabismus surgery.