title: Strabismus after inferior-medial wall orbital decompression in thyroid-related orbitopathy.
abstract: OBJECTIVE
  To evaluate the rate and pattern of new-onset diplopia after inferior-medial wall orbital decompression in thyroid-related orbitopathy (TRO) patients.
  
  
  METHODS
  Medical records of TRO patients who underwent orbital floor and medial wall decompression at the Goldschleger Eye Institute, Sheba Medical Center between 1/1986 and 12/2007 were reviewed and analyzed.
  
  
  METHODS
  primary- and down-gaze diplopia, strabismus (prism diopter [PD]).
  
  
  RESULTS
  Fifty-one TRO patients (30 females, mean age of 51 years) underwent 102 bilateral inferior-medial wall orbital decompressions. Preoperatively, 29 patients (57%) reported primary gaze diplopia. Of these, 13 patients (45%) had persistent or worsened diplopia postoperatively, all of which required strabismus surgery. Fifteen patients had no primary gaze diplopia preoperatively. Of these, five patients (33%) had new-onset diplopia postoperatively, and only one patient (7%) required strabismus surgery. No data regarding pre-existing diplopia were available in seven patients. Orbital decompression had a significant effect on horizontal ocular deviations with increasing esotropic shift. Primary position esotropia increased from 11.1 (± 22.5) PD preoperatively to 23.8 (± 20.5) PD after surgery (p = 0.01, paired samples t-test). No severe complications were encountered in this group of patients.
  
  
  CONCLUSIONS
  Inferior-medial wall orbital decompression is associated with a relatively high rate of new-onset diplopia of up to 33%. Patients with pre-existing primary and/or downgaze diplopia are more likely to have persistent symptoms postoperatively that may require strabismus surgery.
authors.affiliation: Orbital and Ophthalmic Plastic Division, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Ido D
authors.initials: ID
authors.lastname: Fabian
authors.forename: Nachum
authors.initials: N
authors.lastname: Rosen
authors.forename: Guy J
authors.initials: GJ
authors.lastname: Ben Simon
mesh_terms: D019299:Decompression, Surgical / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology* / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D013285:Strabismus / Q000453:epidemiology / Q000209:etiology*