title: Surgical management of dysthyroid diplopia with preservation of the anterior ciliary vascularization: review of ten cases.
abstract: OBJECTIVE
  During the surgical correction of dysthyroid diplopia, the risk of ischemia by transection of the anterior ciliary arteries is well-known. In order to avoid this, we modified the classical surgical technique: (1) through the preservation of the vascular pedicles during muscle recession and (2) if necessary, through a plication (instead of a resection) of the ipsilateral antagonist muscle. The objective to be achieved is thus the resolution of the diplopia without ischemic complications.
  
  
  METHODS
  We report a prospective series of 10 patients with dysthyroid ophthalmopathy, causing strabismic diplopia, all operated on by the same surgeon (BR) after at least 12 months of euthyroidism. Data collection included: history of previous decompressive surgery, surgical procedure, and oculomotor status before and after surgery.
  
  
  RESULTS
  Ten patients (8 females), aged 51 to 74 years (mean age, 58.00 ± 7.62 years), were collected between 2008 and 2012. All patients had one or more vascular risk factors (diabetes, smoking, obesity, high blood pressure). With a follow-up from 16 to 67 months (mean ± SD 27.7 months ± 14.87), surgical outcomes were excellent: diplopia was cured in all cases, with recovery of stereoscopic vision. We had no operative or postoperative complications.
  
  
  CONCLUSIONS
  The technique of preservation of the anterior ciliary vascularization, which is particularly justified for these fragile patients, is compatible with moderate muscle recessions. For larger deviations, in which a larger recession might increase the proptosis, it is possible to add a plication of the ipsilateral antagonist. This surgical technique made possible the suppression of the diplopia in all cases.
authors.affiliation: Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France. Electronic address: b.roussat@quinze-vingts.fr.
authors.forename: B
authors.initials: B
authors.lastname: Roussat
authors.affiliation: Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
authors.forename: W
authors.initials: W
authors.lastname: Kilani
authors.affiliation: Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: de Preobrajensky
authors.affiliation: Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Berche
authors.affiliation: Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Du Pasquier
authors.affiliation: Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Paques
mesh_terms: D000368:Aged; D019842:Ciliary Arteries / Q000601:surgery*; D004172:Diplopia / Q000209:etiology / Q000601:surgery*; D005260:Female; D049970:Graves Ophthalmopathy / Q000150:complications / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies
keywords: Basedow; Graves’ disease; Hashimoto; Ischémie sclérale; Ophtalmopathie; Ophthalmopathy; Plication; Plissement; Recession; Recul; Scleral ischemia; Surgical technique; Technique chirurgicale