Czech and Slovak Ophthalmology 555 Original article Adjustable Versus Non-adjustable Sutures in Strabismus Surgery in Patients with Thyroid Orbitopathy Karhanová Marta https://orcid.org/0000-0002-0879-3055 Vláčil Ondřej Šín Martin https://orcid.org/0000-0002-5073-9482 Marešová Klára https://orcid.org/0000-0002-9973-3145 22 10 2012 5 6

Aim: To evaluate the results of strabismus surgery in patients with thyroid ophthalmopathy. To determine whether adjustable suture surgery is beneficial for these patients. Materials and methods: This study included patients who underwent strabismus surgery associated with thyroid ophthalmopathy from June 2010 to March 2012. During the observation period, 14 patients met the inclusion criteria. Seven patients underwent non-adjustable suture surgery (five women and two men) and seven patients underwent adjustable suture surgery (five women and two men). The patients’ mean age was 63 years. The preoperative ocular findings were stable for at least one year in all cases. All strabismus surgeries were performed by one surgeon. The postoperative results were recorded at follow-up visits after 1 week, 1 month, 3 months and 6 months. Results: In the non-adjustable suture case series, three patients were satisfied with the results (including one with a compensatory head posture). Two patients required reoperation and two prismatic correction. In the adjustable suture case series, no reoperation or prismatic correction was needed. In this group, all the patients were satisfied with the results (including one with a compensatory head posture). Conclusion: Adjustable suture strabismus surgery in patients with thyroid ophthalmopathy proved to be beneficial. In our adjustable suture case series, there was a lower number of reoperations and prismatic corrections.

 restrictive strabismus thyroid ophthalmopathy adjustable sutures diplopia References We do not perform restrictive strabismus surgery on patients with endocrine orbitopathy until the calm phase of the disorder. Before the operation the ocular finding must be stable for a minimum of 6 months if the patient’s psychological condition so allows, and we recommend waiting for at least 1 year. No signs of EO activity may be present. Disorder of the thyroid gland must be stabilised. Bishop, F., Doran, R.M.: Adjustable and non-adjustable strabismus sur- gery: a retrospective case-matched study. Strabismus, 2004; 12: 3–11. During the operation on this type of strabismus we now unequivocally prefer the adjustable sutures method. We target the actual postoperative result primarily towards slight undercorrection. We perform adjustment 2 to 6 hours after the operation. We check the result of the adjustment always also with the patient’s own correction by eyeglasses. Currie, Z.I., Shipman, T., Burke, J.P.: Surgical correction of large- -angle exotropia in adults. Ey- e(Lond), 2003; 17: 334–9. We place great emphasis on thorough patient education and emphasise the aim of the operation. In general the most difficult step in restrictive strabismus surgery on patients with EO is correct timing of the procedure and the creation of a suitable operation plan. An essential precondition is very good knowledge of this issue. Upon adherence to the fundamental regulations (thorough examination, suitable operation plan and technique) it is now currently possible to achieve clearance of diplopia and restoration of a sufficiently large field of binocular simple vision in the majority of patients. The positive impact of a successfully performed operation on the quality of life of these patients is enormous (9, 14). Del Canto, A.J., Crow, S., Perry, J.D. et al.: Intraoperative relaxed muscle positioning technique for strabismus repair in thyroid eye di- sease. Ophthalmology, 2006; 113: 2324–2330. Evans, D, Kennerdell, J.S.: Extra- ocular muscle surgery for dysthy- roid myopathy. Am J Ophthalmol, 1983; 95: 767–771. Ferková, S., Chynoranský, M., Podoba, J. et al.: Spolupráca oftal- mológa a endokrinóloga při liečbě endokrinnej orbitopatie. Čes a slov Oftal, 2007; 63(2): 108-116. Hatt, S.R., Leske, D.A., Kirgis, P.A. et al.: The effects of strabismus on quality of life in adults. Am J Oph- thalmol, 2007; 144: 643–7. Keech, R.V., Scott, W.E., Christen- sen L.E.: Adjustable suture strabismus surgery. J Pediatr Ophthalmol Strabismus, 1987; 24: 97–102. Keech, R.V., Hecker, R.R.: Adjus- table suture strabismus surgery for aquired vertical deviations. J Pediatr Ophthalmol Strabismus, 1988; 25: 159–63. Kerr, N.: The role of thyroid eye disease and other factors in the overcorrection of hypotropia fo- llowing unilateral adjustable suture recession of the inferior rectus (An American ophthalmological society thesis). Trans Am Ophthalmol Soc, 2011; 109: 168–200. Krásný, J., Brunnerová, R., Syslo- vá J. et al.: Desetiletý rozbor ope- rací poruch motility na Oční klinice FNKV v Praze. Čes. a slov. Oftal., 2007; 63(4): 249–261. Liláková, D., Hejcmanová, D., No- váková, D.: Vliv strabismu na kva- litu života dospělých. Čes a slov Oftal, 2003; 59(3): 184–187. Lueder, G., T., Scott, W.E., Kut- sche, P.J. et. al.: Long-term results of adjustable surgery for strabis- mus secondary to thyroid ophthal- mopathy. Ophthalmology, 1992; 99: 993–7. Nardi, M.: Squint surgery in TED – hints and fints, or why Gravesę patients are difficult patiens. Orbit, 2009; 28(4): 245–250. Nguyen, V.T., Park, D.J.J., Levin, L. et al.: Correction of restricted ex- traocular muscle motility in surgical management of strabismus in Gra- vesę ophthalmopathy. Ophthalmo- logy, 2002; 109: 384–388. Pellarová, H., Autrata, R., Unčov- ská, E. et. al.: Výsledky chirurgie strabismu dospělých. Čes a slov Oftal, 2009; 65(6): 208–216. Rajendram, R., Bunce, C., Adams, G. at al.: Smoking and strabismus surgery in patiens with thyroid eye disease. Ophthalmology, 2011; 118: 2493–2497. Scott, W.E., Thalacker, J.A.: Dia- gnosis and treatment of thyroid myopathy. Ophthalmology, 1981; 88: 493–498. Skov, C.M., Mazow, M.L.: Ma- naging strabismus in endocrine eye disease. Can J Ophthalmol, 1984; 19: 269–274. Sprunger, D.T., Helveston, E.M.: Progressive overcorrection after inferior rectus recession. J Pediatr Ophthalmol Strabismus, 1993; 30: 145–148. Stan, M.N., Bahn, R.S.: Risk fac- tors for development or deteriora- tion of Gravesę ophthalmopathy. Thyroid, 2010; 20:777-83. Sundaram, V., Haridas, A..: Ad- justable versus non-adjustable sutures for strabismus. Cochra- ne diabase Syst Rev, 2005; (1): CD004240. Thorton, J., Kelly, S.P., Harrison, R.A. et al.: Cigarette smoking and thyroid eye disease: a systematic review. Eye, 2007; 21: 1135–45. Tripathi, A., Haslett, R., Marsh, I.B. et al.: Strabismus surgery: adjus- table sutures – god for all? Eye (Lond), 2003; 17, 739–42. Wright, K.W.: Late overcorrection after inferior rectus recession. Oph- thalmology, 1996; 103: 1503-1507. Zhang, M.,S.,Hutchinson, A.K., Drack, A.V. et al.: Improved ocular alignment with adjustable sutures in adults undergoing strabismus surgery. Ophthalmology, 2012; 119: 396–402.