Muscle surgery in patients with Graves' disease using topical anesthesia.
OBJECTIVE
To report our experience in extraocular muscle surgery for Graves' disease using topical anesthesia.


METHODS
Retrospective, noncomparative, observational case series.


METHODS
In 135 patients with Graves' disease, a total of 200 ocular muscles were operated during the past 20 years at the Department of Ophthalmology, Ludwig-Maximilian-University, Munich, Germany.


METHODS
Surgery was performed under topical anesthesia with tetracaine hydrochloride 1% eyedrops. Because of the restrictive nature of the motility impairment, recession of the muscles was used in all patients. The exact amount of recession was determined during the operation with active cooperation from the patient.


METHODS
Binocular single vision and the angle of deviation were evaluated preoperatively and postoperatively.


RESULTS
Postoperative binocular single vision in the primary position was achieved by 78.7% of the patients on the first postoperative day. Subsequent evaluation demonstrated binocular single vision in 91.9% of all patients and in 96.4% of the group with only 1 muscle (inferior rectus) operated.


CONCLUSIONS
The authors have demonstrated that topical anesthesia is a feasible and reliable method for performing extraocular muscle surgery in patients with Graves' disease. Intraoperative patient discomfort seemed insignificant, and the active cooperation of the patient in finding the appropriate extent of surgery was advantageous. The overall results showed that deviation surgery with the use of topical anesthesia is highly successful in restoring binocular single vision in patients with endocrine orbitopathy.
Kalpadakis
Petros
P
University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany. Peter.Kalpadakis@ak-i.med.uni-muenchen.de
Rudolph
Guenther
G
Mueller
Arthur
A
Boergen
Klaus-Peter
KP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005133:Eye Movements / Q000502:physiology; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D012189:Retrospective Studies; D013748:Tetracaine / Q000008:administration & dosage*; D015348:Vision, Binocular / Q000502:physiology
D000779:Anesthetics, Local; D013748:Tetracaine