• adjustable sutures
• dysthyroid strabismus
• basedow

Background
Autoimmune dysthyroidism may result in a form of restrictive
strabismus characterized by a severe reduction of ocular motility
and patient’s quality of life. In case of diplopia not manageable
with prisms and/or in case of abnormal head position (AHP) not
tolerated by patient, surgical treatment is the gold standard
procedure.
Methods
Prospective, monocentric study. All enrolled patients
presented a stable thyroidal disease from at least 6 month and
were subjected to muscular recession associated with
adjustable sutures. Primary endpoints of this study were
subjective diplopia (evaluated with Gorman Score), residual
deviation (measured in prismatic diopters, PD), field of single
binocular vision (evaluated with Sullivan Score) and patients’
quality of life (evaluated with GO-QoL questionnaire). This
study also investigated the influence of previous GO
treatments (corticosteroids, radiotherapy and orbital
decompression) on the baseline deviation and on final results.
Results
Forty-seven patients (31 females and 16 males with a mean age
of 55,91±8,73 years) have been enrolled. Scheduled visits have
been performed at baseline, 1 day after surgery, on month, 6
4
and 12 months. All patients completed one year follow-up. At
baseline visit all patients presented constant diplopia (Gorman
score = 1) with a mean total deviation of 36,70±14,69 PD in
primary gaze, a 27,08±16,99 PD mean horizontal deviation
and a 23,67±12,01 PD mean vertical deviation. One year after
surgery only 2,27% of patients referred constant diplopia not
manageable with prisms. Mean residual total deviation at 12
months after surgery was 3,66±6,42 PD in primary gaze while
mean residual horizontal deviation was 1,89 ± 4,53 PD and
mean residual vertical deviation was 3,47±5,49 PD. Field of
binocular single vision expanded from 31,89± 6,67% to
83,7±3,99% while GO-QoL improved from 20,91± 4,50% at
baseline to 89,22±3,22 % at one year visit. Previous CS therapy
demonstrated a positive effect on vertical deviation both for
baseline and final residual deviation. RT demonstrated a good
influence on residual final vertical deviation; this result was
better when OTD was also performed.
Conclusions
Muscular weakening with adjustable sutures represents a safe
and an effective procedure for dysthyroid strabismus
correction and usually determines a significant improvement
in patients’ quality of life. Corticosteroids and Radiotherapy
have a positive effect on residual deviation at one year followup
especially for vertical deviation.