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Park, Lee, Yoon, and Rhiu: Evaluation of Prognostic Factors and Outcomes of Single-Stage Adjustable Strabismus Surgery in Thyroid Eye Disease
Original Article

J Korean Ophthalmol Soc 2015;56(4):573-579.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.04.573

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

Hyun Ju Park, MD1, Jong Bok Lee, MD1, Jin Sook Yoon, MD, PhD1, Soolienah Rhiu, MD2

1Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

2Department of Ophthalmology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea

￭ Address reprint requests to Soolienah Rhiu, MD Department of Ophthalmology, Hallym University Dongtan Sacred Heart Hospital, #7 Keunjaebong-gil, Hwaseong 445-907, Korea Tel: 82-31-8086-2861, Fax: 82-31-8086-2029 E-mail: soolienah99@naver.com

Received 24 May 20145 October 2014       Accepted 7 March 2015

Copyright © 2015 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

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 fol-low-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.

Keywords: Adjustable strabismus surgery, Thyroid eye disease

References

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Figure 1.
Postoperative deviation in success group and failure group. Mann-Whitney U test was used for statistical analysis. * p-value < 0.05. POD = postoperative day.
jkos-56-573f1.tif
Table 1.
Clinical characteristics between success group and failure group
Parameters Success group (n = 24) Failure group (n = 6) p-value
Sex (M:F) 11:13 1:5 0.36*
Graves’ disease onset age (years) 49.5 ± 13.9 44.3 ± 8.4 0.40†
Graves’ disease duration (months) 53.7 ± 96.2 11.5 ± 13.2 0.30†
GO onset age (years) 51.5 ± 14.0 45.0 ± 9.4 0.30†
GO duration (months) 34.1 ± 78.1 6.17 ± 3.2 0.38†
History of autoimmune disease or DM (N:Y) 22:2 6:0 1.00*
Family history of thyroid disease (N:Y) 24:0 5:1 0.20*
Smoking status (current:previous:nil) 2:3:19 0:1:5 1.00*
Mean preoperative CAS 1.9 ± 1.4 2.5 ± 1.5 0.33†
Laterality (unilateral:bilateral) 7:17 2:4 1.00*
Proptosis (N:Y) 13:10 0:6 0.02*
Optic neuropathy (N:Y) 19:5 1:5 0.01*
Lid retraction (N:Y) 5:19 0:6 0.56*
BCVA of right eye (Snellen) 0.80 ± 0.27 0.82 ± 0.22 0.77†
BCVA of left eye (Snellen) 0.78 ± 0.25 0.78 ± 0.31 0.95†

Values are presented as mean ± SD unless otherwise indicated.

GO = Graves’ ophthalmopathy; DM = diabetes mellitus; N = no; Y = yes; CAS = clinical activity score; BCVA = best corrected visual acuity.

* p-value for Fishers’ exact test;

† p-value for Mann-Whitney U test.

Table 2.
Preoperative anti-thyroid treatments between success group and failure group
Parameters Success group (n = 24) Failure group (n = 6) p-value
Anti-thyroid medication (N:Y) 1:23 0:6 1.00*
History of thyroidectomy (N:Y) 20:4 3:3 0.12*
History of Iodide Tx (N:Y) 21:3 6:0 1.00*
History of radiotherapy (N:Y) 23:1 5:1 0.37*
History of parenteral steroids (N:Y) 4:20 0:6 0.56*
History of IV steroids (N:Y) 14:10 0:6 0.02*
No. of IV steroid pulse Tx 0.8 ± 1.2 2.3 ± 1.9 0.01†
Interval between last steroid Tx and strabismus surgery (months) 18.9 ± 15.0 13.5 ± 7.3 0.43†
History of orbital decompression (N:Y) 17:7 1:5 0.03*

Values are presented as mean ± SD unless otherwise indicated.

Tx = therapy; IV = intravenous; N = no; Y = yes.

* p-value for Fishers’ exact test;

† p-value for Mann-Whitney U test.

Table 3.
Thyroid function test between success group and failure group
Parameters Success group (n = 24) Failure group (n = 6) p-value
TSH 1.4 ± 1.9 1.5 ± 3.0 0.86†
T3 1.5 ± 0.6 1.4 ± 0.6 0.64†
fT4 1.4 ± 0.6 1.4 ± 1.0 0.96†
TBII 40.5 ± 31.2 41.2 ± 25.5 0.94†
TSH receptor Ab 11.3 ± 12.2 40.3 ± 15.7 0.53†
Thyroid stimulating Ab 459.6 ± 169.0 357.1 ± 182.7 0.17†
Thyroglobulin 58.8 ± 62.5 841.1 ± 2639.4 0.52†
Thyroglobulin Ab 73.0 ± 181.0 230.1 ± 552.4 0.31†
Microsome Ab 325.6 ± 817.3 458.4 ± 945.2 0.67†
TSH degree (L:N:H) 9:8:7 2:2:2 0.10*
T3 degree (L:N:H) 1:14:9 0:0:6 0.17*
fT4 degree (L:N:H) 2:15:7 1:2:3 0.88*
TSH Ab degree (L:N:H) 0:4:20 0:2:4 0.06*
Thyroglobulin Ab (L:N:H) 0:16:8 0:4:2 0.37*
Microsome Ab (L:N:H) 0:11:13 0:2:4 0.69*

Values are presented as mean ± SD unless otherwise indicated.

TSH = thyroid stimulating hormone; T3 = triiodothyronine; fT4 = free thyroxine; Ab = antibody; TBII = thyrotropin binding inhibitory immunoglobulin; L = low; N = normal; H = high.

* p-value for Fishers’ exact test;

† p-value for Mann-Whitney U test.

Table 4.
Parameters in relation to strabismus surgery between success group and failure group
Parameters Success group (n = 24) Failure group (n = 6) p-value
Interval between GO onset and surgery (months) 34.8 ± 71.6 22.3 ± 13.8 0.68
Deviation stabilization duration (months) 7.7 ± 4.5 7.7 ± 1.9 1.00
Deviation at first visit (H+V) (PD) 30.1 ± 20.8 34.3 ± 16.9 0.65
Duction at first visit -5.0 ± 3.3 -7.0 ± 6.1 0.29
Age at surgery (years) 54.3 ± 13.2 46.7 ± 8.9 0.20
Preoperative deviation (H+V) (PD) 36.2 ± 19.7 49.2 ± 18.0 0.15
Preoperative duction -5.3 ± 3.6 -7.8 ± 5.8 0.19
Total amount of recession (mm) 8.7 ± 4.4 11.3 ± 3.4 0.18
No. of operated recti muscles 1.4 ± 0.7 1.8 ± 0.8 0.21

Values are presented as mean ± SD; Mann-Whitney U test was used for statistical analysis.

GO = Graves’ ophthalmopathy; H = horizontal; V = vertical; PD = prism diopter.

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