[Surgical correction of strabismus in Graves-Basedow ophthalmopathy. Personal experiences].

UNLABELLED: The aim of the study was to evaluate long-term results of surgical treatment of strabismus and diplopia connected with Graves' ophthalmopathy. Surgery of extraocular muscles was performed in 64 patients, previously with different methods for their Graves' ophthalmopathy. All patients showed stabilization of the strabismus angle and diplopia as well as euthyroidism. Before the operation ultrasonography, orbital computed tomography and forced duction test were performed. Before the operation horizontal strabismus with vertical deviation and vertical strabismus were most frequent (36.6% and 35.2%, respectively). A total of 136 operations had been performed. Postoperative follow-up ranged from 6 months to 15 years, including 30 patients with the follow-up exceeding one-year. Recovery or recovery without binocular single vision after surgery was observed in 47 patients (73.4%), including 34 patients (53.1%) with single binocular vision. Improvement was seen in 15 patients (23.4%). No improvement was observed in two cases (3.1%) due to marked vertical strabismus before surgery, they were referred for further surgical treatment. Overcorrection after surgery in 3 cases was observed, and in one case we applied prismatic correction successfully, the two others required reoperation.

CONCLUSIONS: 1. Surgical treatment of strabismus and diplopia in Graves' ophthalmopathy is very useful because of high percentage of positive results, confirmed in long-term observation. 2. Diplopia and a large angle of strabismus are a necessary indication for surgical correction of extraocular muscles. 3. A prerequisite for surgical treatment is stable euthyreosis and stabilization of the strabismus angle as well as diplopia and performation of forced duction test for evaluation of stage disease. 4. Prior treatment of ophthalmopathy and duration of strabismus as well as diplopia do not appear to influence this outcome.