title: Torsional diplopia after transantral orbital decompression and extraocular muscle surgery associated with Graves' orbitopathy.
abstract: Graves' orbitopathy can be associated with horizontal, vertical, and torsional diplopia. Of 428 patients treated with transantral orbital decompression, 21 had incycloduction (mean, 12.8 degrees; range, 5 to 20 degrees) and five had excycloduction (mean, 12 degrees; range, 5 to 20 degrees). All 26 patients had had recessions of the medial or inferior rectus muscle (or both) before onset of torsional diplopia. Mean recession was 5.5 mm (range, 4 to 10 mm) and 5.3 mm (range, 2 to 10 mm) of medial rectus muscle and inferior rectus muscle, respectively. An A pattern was often associated with the condition. Superior oblique tenectomy and inferior oblique myectomy were performed most frequently for incycloduction and excycloduction, respectively. Superior oblique tenectomy induced a mean incycloduction decrease of 7.1 degrees (range, 0 to 12 degrees). Exotropia in downgaze was decreased, and a small ipsilateral hyperdeviation was induced. Bilateral inferior oblique myectomy in one patient decreased excycloduction 10 degrees without inducing new deviation. At follow-up (mean, 63.7 months) after last strabismus operation, 15 patients with incycloduction and two with excycloduction had no diplopia.
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905.
authors.forename: J A
authors.initials: JA
authors.lastname: Garrity
authors.forename: D D
authors.initials: DD
authors.lastname: Saggau
authors.forename: C A
authors.initials: CA
authors.lastname: Gorman
authors.forename: G B
authors.initials: GB
authors.lastname: Bartley
authors.forename: V
authors.initials: V
authors.lastname: Fatourechi
authors.forename: P W
authors.initials: PW
authors.lastname: Hardwig
authors.forename: J A
authors.initials: JA
authors.lastname: Dyer
mesh_terms: D000328:Adult; D000368:Aged; D004172:Diplopia / Q000209:etiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D009915:Orbit / Q000601:surgery*; D011183:Postoperative Complications; D013285:Strabismus / Q000601:surgery; D016896:Treatment Outcome