title: Tenon recession: a novel adjunct to improve outcome in the treatment of large-angle strabismus in thyroid eye disease.
abstract: OBJECTIVE
  Treatment of large-angle strabismus in thyroid eye disease has historically suffered from low success rates. The authors report a novel technique that adds Tenon recession without conjunctival recession to standard extraocular muscle surgery.
  
  
  METHODS
  Twenty-six patients with thyroid eye disease-associated strabismus with preoperative deviations of ≥ 25 prism diopters in horizontal or vertical deviations underwent strabismus surgery. The amount of recession for a given muscle was determined by a combined analysis of the preoperative versions, deviation in primary gaze and in gaze opposite the restricted muscle, and intraoperative forced duction testing. Before conjunctival closure, the underlying Tenon layer and associated orbital tissues were recessed and allowed to retract posteriorally. The overlying conjunctiva was subsequently reapproximated to its anatomic position without tension.
  
  
  RESULTS
  The average preoperative measurements for horizontal and vertical deviations were 39.2 ± 13.4 and 45.0 ± 18.9 prism diopters, respectively. Average postoperative measurements for horizontal and vertical deviations were 3.2 ± 6.0 and 11.1 ± 11.9 prism diopters, respectively. Overall, 22 of 26 patients (84.6%) were within 10 prism diopters of intended correction postoperatively and achieved binocular fusion with or without the use of prisms for both distance and near vision. Four had residual deviations that required reoperation, all of which successfully produced binocular vision without the use of prisms.
  
  
  CONCLUSIONS
  In the authors' experience, Tenon recession improves outcomes in surgery for large-angle strabismus in thyroid eye disease.
authors.affiliation: Department of Ophthalmology, Division of Ophthalmic Plastic and Reconstructive Surgery, Edward S Harkness Eye Institute, Columbia College of Physicians and Surgeons, New York, New York 10032, USA.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Zoumalan
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Lelli
authors.forename: Michael
authors.initials: M
authors.lastname: Kazim
mesh_terms: D000368:Aged; D004172:Diplopia / Q000517:prevention & control; D005260:Female; D049970:Graves Ophthalmopathy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D013285:Strabismus / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology