Operacyjne leczenie zeza i podwójnego widzenia w orbitopatii w przebiegu choroby Gravesa-Basedowa
Surgical Treatment of the Strabismus and Diplopia in Orbitopathy Due to the Graves-Basedow Disease
Oddział Leczenia Zeza i Niedowidzenia Wojewódzkiego Szpitala Okulistycznego w Krakowie Witkowicach Ordynator: dr n. med. Ewa Wójcik
Summary: Ocular symptoms of the ophthalmopathy and orbitopathy due to the Grave-Basedow disease include eyelids retraction, changes in soft tissues and in the anterior segment of the eye, egzophthalmus, changes in extraocular muscles the most often with strabismus and diplopia and changes in the optic nerve. Due to the therapeutic management there are two phases of the ophthalmopathy and orbitopathy ? active and inactive. Active phase of the disease is the indication for surgical management of the strabismus and diplopia. Disorders in motility and position of the globes are caused by fibrosis including mostly inferior rectus muscle, medial rectus muscle, rarely oblique inferior and superior muscle. In orbitopathy there are three types of strabismus: isolated vertical strabismus, horizontal strabismus ? the most often convergent, horizontal strabismus with vertical deviation. Necessary conditions for surgical treatment employment are: large strabismus angle and permanent diplopia, which is impossible to correct with other methods use, stabilization of the strabismus angle value and diplopia for 3 months, active phase of the disease absence, permanent euthyreosis for 6 months. The most proper moment for surgery performance is period prior to the muscle fibrosis phase or the very beginning of this phase. One of the most frequently performed surgeries on extraocular muscles include procedures consisting in reversing fibrous muscle or fibrous muscle reversion with concomitant shortening its' homolateral antagonist. Surgery range depends on strabismus angle volume before surgery, intraoperative result of the passive motility test or result of the active globe motility test. Very good results of the surgical treatment i. e. orthoposition, lack of diplopia while looking straight ahead and down without compensatory head positioning, obtains the most often in patients with vertical strabismus, slightly rarely in patients with convergent strabismus. The smallest favorable results of the surgical treatment are noted in patients with horizontal strabismus with vertical deviation. Postoperative complications include: edema of lids and ocular conjunctiva, lower lid retraction, anterior segment ischemia and overcorrection.
Keywords: Grave's ophthalmopathy and orbitopathy, strabismus, diplopia, extraocular muscle surgery