Unilateral and bilateral medial rectus recession in Graves' Orbitopathy patients

To evaluate the effect of uni- and bilateral medial rectus recession on squint angle and ductions in Graves' Orbitopathy (GO) patients. Retrospective case series. Consecutive GO patients seen between January 2000 and March 2012 who were operated on one or both medial rectus muscles were selected for the study. Data regarding squint angle, abduction, and adduction were collected starting 3 months before surgery and 3 and 6-12 months after surgery. 102 patients were eligible for inclusion. Of these, 24 patients were operated on one medial rectus and 78 on two medial rectus muscles. The dose-effect response was 1.0 [-0.6-3.8]°/mm in the unilateral and 1.4 [0.2-3.0]°/mm in the bilateral group (p=0.000). In the bilateral group, the maximal abduction and adduction changed significantly (p=0.000). However, the total duction range remained unchanged (unilateral: p=0.525; bilateral: p=0.137). The extent of the preoperative abduction did not influence the dose-effect response (r=-0.234; p=0.040), nor did the muscle volume (unilateral p=0.989; bilateral p=0.397). Twenty-three patients (23%) needed additional horizontal squint surgery. In this large series of medial rectus recessions in patients with Graves' disease we found significantly lower dose-effect response ratios as compared to other studies. The amount of abduction deficit does not influence outcom

Proposal of success criteria for strabismus surgery in patients with Graves' orbitopathy based on a systematic literature review

Proposal of success criteria for strabismus surgery for patients with Graves' orbitopathy (GO) based on a systematic review of the literature. We performed a systematic search of OVID MEDLINE, OVID Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and the publisher subset of PubMed, to identify studies reporting on success criteria of strabismus surgery in GO. In addition, we handsearched several orthoptic journals and proceedings of strabismological congresses. Of the 789 articles retrieved, 42 articles described success criteria for strabismus surgery in GO. Most studies defined success in terms of a subjective diplopia-free field in primary and down gaze. Almost half of the studies used a graded scale (excellent, good, acceptable and failure) to describe the outcome of surgery. Three of the eligible studies described a tool to quantify the field of single vision in detail. Quality of life was not reported as an outcome measure in any of the published studies. In conclusion, success criteria for strabismus surgery in patients with GO are poorly defined and no consensus is available. The lack of standardization hampers comparative studies and thus the search for the best surgical treatment for diplopia in patients with GO. Therefore, we propose strict success criteria including a tool for quantification of remaining diplopia plus a disease-specific quality of life questionnaire (the GO-QoL

Anomalous relation between axial length and retinal thickness in amblyopic children

To investigate the relationship between retinal thickness and axial length in amblyopic eyes compared to healthy eyes. In this observational, transversal study, 36 amblyopic children and 30 healthy controls underwent full ophthalmological and orthoptic examinations, volume scanning of the macula with spectral domain optical coherence tomography (3D OCT-1000; Topcon Corporation, Tokyo, Japan), and measuring of axial length using the IOLMaster (Carl Zeiss Meditec AG, Jena, Germany). The average pericentral retinal thickness was calculated. A strong correlation was observed between the axial lengths of both eyes in the control group (R = 0.98, P < 0.01) and between the axial lengths of the amblyopic and fellow eye in the amblyopic group (R = 0.77, P < 0.01); the amblyopic and their fellow eyes were significantly shorter than the nonamblyopic control eyes. The pericentral retinal thickness of both eyes of an individual is highly correlated in nonamblyopic controls (R = 0.92, P < 0.01) and in amblyopic children (R = 0.82, P < 0.01). There is no significant difference in mean pericentral retinal thickness between healthy, amblyopic, and fellow eyes. In healthy eyes a moderate inverse correlation exists between axial length and pericentral retinal thickness (R = -0.41, P = 0.02); this relationship was not found in the amblyopic eyes or the normal fellow eye. In this patient cohort, there was an anomalous relation between the axial length and the pericentral retinal thickness in both amblyopic and their fellow eye