Our Summary

This research shows the results of eye alignment surgery, also known as strabismus surgery, in patients with a condition called Graves’ orbitopathy (GO). This condition is related to an overactive thyroid and can cause eye problems such as double vision or bulging eyes.

From 2014 to 2021, the researchers studied 45 patients who had their first strabismus surgery in their department. About a third of the patients came from outside their health region because their cases were complex. Over half of the patients had undergone another type of surgery called orbital decompression before the strabismus surgery.

The researchers used a method called topical anesthesia for the surgeries and adjusted the sutures (stitches) during the operation. This method was successful in 82% of the patients. There were no cases of triggering a certain reflex that can slow the heart rate during the procedure.

Out of the 36 patients who had follow-up checks for at least two months after the surgery, about a third needed more surgery. About a fifth of the patients had an overcorrection, meaning their eyes were aligned too much in the opposite direction. However, at the last check-up, 89% of the patients no longer had double vision when looking straight ahead or downward, either naturally or with the help of weak prism glasses.

In conclusion, the study suggests that this method of strabismus surgery is suitable and safe for most patients with GO, even difficult and complex cases. However, patients should be told beforehand that they may need more surgery or need to wear prism glasses after the operation.

FAQs

  1. What is the success rate of strabismus surgery with topical anaesthesia in patients with Graves’ orbitopathy?
  2. What percentage of patients needed further surgery after undergoing strabismus surgery with topical anaesthesia?
  3. What is the possibility of additional surgery or post-operative need for prism glasses after strabismus surgery with topical anaesthesia in patients with Graves’ orbitopathy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about strabismus surgery is to be prepared for the possibility of needing additional surgery or post-operative prism glasses. It is important for patients to have realistic expectations and be informed about potential outcomes following the procedure. Communication with the doctor about any concerns or changes in vision post-surgery is also crucial for successful recovery.

Suitable For

Patients with Graves’ Orbitopathy (GO) who have strabismus are typically recommended for strabismus surgery. In this study, 82% of patients with GO were able to undergo surgery with topical anesthesia and intraoperative suture adjustment. Patients who had undergone orbital decompression surgery prior to strabismus surgery were also included in the study. Most patients (89%) were diplopia-free at the last follow-up examination, either with or without weak prisms. However, 31% of patients required additional surgery, and late overcorrection after recession of the inferior rectus was seen in 19% of cases. Overall, strabismus surgery with topical anesthesia and intraoperative suture adjustment was found to be a suitable and safe procedure for patients with GO, including those with complex cases. Patients should be informed about the possibility of needing additional surgery or prism glasses post-operatively.

Timeline

Before strabismus surgery:

  • Patient is diagnosed with Graves’ orbitopathy (GO) and referred for strabismus surgery
  • Patient may undergo orbital decompression surgery prior to strabismus surgery
  • Patient consults with an ophthalmologist and discusses the surgical procedure
  • Pre-operative tests and evaluations are performed to assess the patient’s eye condition and overall health
  • Patient receives instructions on pre-operative care and what to expect during and after surgery

After strabismus surgery:

  • Patient undergoes strabismus surgery with topical anaesthesia and intraoperative suture adjustment
  • Patient is monitored for any complications during and after the procedure
  • Patient may experience temporary discomfort, redness, and swelling in the operated eye
  • Patient follows post-operative care instructions provided by the ophthalmologist
  • Patient attends follow-up appointments to monitor progress and adjust treatment if necessary
  • Patient may need further surgery or require prism glasses for optimal vision correction
  • Patient achieves improved eye alignment and reduced diplopia, with the majority of patients being diplopia-free in primary and down-gaze position at the last control examination

What to Ask Your Doctor

Some questions a patient should ask their doctor about strabismus surgery for Graves’ orbitopathy include:

  1. Can the surgery be done under topical anesthesia with intraoperative suture adjustment?
  2. What is the success rate of strabismus surgery in patients with Graves’ orbitopathy?
  3. How many follow-up appointments will be needed after the surgery?
  4. What are the potential risks and complications associated with the surgery?
  5. Will I need further surgeries or additional treatments after the initial surgery?
  6. How long is the recovery period after strabismus surgery?
  7. Will I need to wear prism glasses or use other visual aids after the surgery?
  8. How soon after the surgery can I expect to see improvements in my eye alignment?
  9. Are there any lifestyle changes or precautions I should take before or after the surgery?
  10. Can you provide me with information or resources on support groups or organizations for patients with Graves’ orbitopathy who have undergone strabismus surgery?

Reference

Authors: Haugen OH, Mellgren AEC, Norli M, Ueland HO. Journal: Acta Ophthalmol. 2025 Mar;103(2):232-239. doi: 10.1111/aos.16784. Epub 2024 Oct 23. PMID: 39441145