The characteristics and surgical outcomes of medial rectus recessions in Graves' ophthalmopathy.

PURPOSE: To evaluate the clinical characteristics and surgical outcomes of medial rectus (MR) recessions in patients with Graves' ophthalmopathy.

PATIENTS AND METHODS: The clinical records of 32 patients with Graves' ophthalmopathy who underwent MR recessions with adjustable sutures for restrictive esotropia were reviewed. The clinical characteristics of patients, the size of the esodeviations, the limitations of ductions, the surgical doses, and observed responses to surgery were recorded and analyzed. Main outcome measures included the ratio of predicted to observed correction for MR recessions, improvement in ductions, and restoration of binocular status.

RESULTS: The mean age of the 32 patients (20 women, 12 men) at surgery was 54.1+/-11.4 years. The mean duration of thyroid eye disease was 4.3+/-5.4 years (range, 1 to 24 years). The ratios of predicted to observed correction for esodeviations at distance and near, respectively, were 2.21+/-1.24 and 2.16+/-1.81 at the time of adjustment and 1.61+/-0.37 and 1.84+/-0.90 at final follow-up. The limitation of abduction improved from -2.3+/-1.3 to -0.75 +/-0.98. Binocular single vision was achieved in 73% of patients, and a further 10% of patients were able to fuse with prisms. A history of decompression was present in 75% of cases. Patients with a history of decompression had more restriction in abduction (-2.49 vs -1.78, P =.061), more frequently required bilateral surgery (75% vs 62.5%), and had a higher ratio of predicted to observed correction (1.71 -0.37 vs 1.37+/-0.28, P = .043).

CONCLUSIONS: Patients with Graves' ophthalmopathy who undergo MR recession for restrictive esotropia are prone to undercorrection. A history of decompression is associated with a less favorable clinical outcome. Augmented surgery, adjustable sutures, or both are recommended for improved surgical outcomes.