AI Article Synopsis
- The study investigates the occurrence of A pattern strabismus in patients with Graves' orbitopathy who undergo surgery on the inferior rectus muscles, and identifies potential predictive factors.
- 59 out of 590 patients developed this strabismus type post-surgery, with notable differences in muscle recession and ocular movement effects compared to a control group.
- The findings suggest a significant link between increased muscle thickness in affected patients and the development of the A pattern, highlighting that nearly half needed additional surgery for proper vision alignment.
Article Abstract
Introduction And Purpose: Patients with Graves' orbitopathy (GO) may develop restricted elevation; this can lead to hypotropia, sometimes in combination with an abnormal head posture. Recession of one or both inferior rectus muscles is the first line surgery to restore eye motility in these patients. However, this may result in A pattern strabismus. This study was performed to determine the rate of occurrence of this type of incomitant strabismus and potential predictive factors.
Methods: All patients undergoing surgery on one or two inferior rectus muscles over a 10-year period were screened retrospectively for the A pattern, defined as a ≥5° difference in squint angle between the primary gaze and downgaze. The extraocular muscle thickness in patients with acquired A pattern was determined by computed tomography (CT) and compared with a control group consisting of patients randomly selected from the total cohort.
Results: In a total of 590 patients, surgery was performed on the inferior rectus muscle(s) during the study period; the A pattern was identified in 59 patients. Simultaneous surgery was performed on one or both medial rectus muscles in 32% of the patients. This group had significant incyclotorsion (p = 0.000) and less depression (p = 0.000) postoperatively. The mean amount of recession was 4.38 ± 1.53 mm in the A pattern group and 3.91 ± 1.37 mm in the control group (p = 0.032). The amount of depression was 50.2° ± 7.4° in the A pattern group and 57.3° ± 4.4° in the control group (p = 0.045). The inferior rectus muscle was significantly thicker in the A pattern than in the control group (p = 0.027), while there was no significant difference in the thickness of the superior oblique muscle between the two groups (p = 0.870). Of all patients with the A pattern, 47% required further surgery to achieve adequate binocular single vision.
Conclusion: Increased preoperative inferior rectus muscle thickness and relatively limited depression could be predictors of postoperative A pattern inferior rectus recession in patients with GO. Step-by-step procedures are preferable in this surgically challenging group of patients.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10087168 | PMC |
| http://dx.doi.org/10.1111/aos.15223 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Ocular neuromyotonia after peribulbar block.
J AAPOS
December 2024
Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts. Electronic address:
A man in his 60s developed an intermittent, variable left hypotropia with symptomatic diplopia following nasal pterygium surgery in the left eye. No tropia was present for most of the day, but a variable left hypotropia of 25 could be provoked with downgaze. There was no history of radiation or other trauma.
View Article and Find Full Text PDFPatterns of Extraocular Muscle Enlargement in Graves' Orbitopathy and Acromegaly.
Thyroid
December 2024
Department of Ophthalmology, Western University, London, Ontario, Canada.
Extraocular muscle (EOM) enlargement occurs in both acromegaly and Graves' disease, but the degree and pattern of enlargement have not been directly compared in these patient groups. This study investigated whether acromegaly and Graves' orbitopathy (GO) are associated with different patterns of EOM enlargement at the time of diagnosis. Retrospective cohort.
View Article and Find Full Text PDFOrbital Septum Posterior to Medial Canthal Tendon Area.
Ophthalmic Plast Reconstr Surg
December 2024
Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital.
Purpose: To examine the anatomy of the orbital septum posterior to the medial canthal tendon area.
Materials And Methods: We performed 3 anatomical dissections in the present study. The first one was a microscopic study in which exenterated specimens from 6 Japanese cadavers (age from 77 to 93 years at death) were cut inferno-horizontally, including the Müller muscle, medial rectus pulley, and lateral rectus pulley, and stained with Masson's trichrome.
Observations on the Etiology of Involutional Entropion.
Ophthalmic Plast Reconstr Surg
December 2024
John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
Purpose: To review evidence supporting proposed anatomic etiologies of involutional entropion and propose additional potential contributing factors.
Methods: A literature review was performed to identify publications describing possible etiologies of involutional entropion. The author's clinical observations and information supporting new proposed causes are presented.
Endoscopic Endonasal Approach to the Inferolateral Intraconal Orbit: An Anatomical Analysis of Exposure and Maneuverability.
Int Forum Allergy Rhinol
December 2024
Department of Otolaryngology and Head & Neck Surgery, Emory University, Atlanta, USA.
Background: Endoscopic endonasal techniques, initially developed for sinonasal tumor resection, have revolutionized the approach to orbital lesions. The emergence of endonasal orbital tumor surgery has prompted anatomical studies focusing on the medial orbit, yet there remains a lack of literature on maneuverability lateral to the optic nerve (ON), with current feasibility assessments relying primarily on the plane of resectability (POR).
Methods: Bilateral anatomical dissections were conducted on four latex-injected human cadaveric heads using an endoscopic medial and inferior orbitotomy and superomedial displacement of the inferior rectus muscle (IRM) to access the inferolateral intraconal quadrant.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!