ULTRASOUND EXAMINATION OF THE ORBIT IN PATIENTS WITH THYROIDASSOCIATED ORBITOPATHY - EXAMINATION GUIDE AND RECOMMENDATIONS FOR EVERYDAY PRACTICE. A REVIEW.

The purpose of this study is to present the possibilities and benefits of ultrasonography (US) of the orbit in the diagnosis and treatment of thyroidassociated orbitopathy (TAO). Methods: US examination of the orbit is an essential addition to clinical and laboratory examination in TAO patients. Nevertheless, it is often neglected in clinical practice or indicated with delay. Based on previously published studies and our experience with the diagnosis and treatment of TAO patients, we aim to highlight the clear benefit of US examination of the orbit and oculomotor muscles, not only for correct TAO diagnosis but also in the monitoring of the disease over time. However, knowledge of the drawbacks and limitations of this method is also essential, as we shall point out. It is always necessary to remember that US examination must be evaluated in connection with the clinical findings. A detailed recommendation for US examination of the extraocular muscles and the orbit based on our experiences with diagnosing and treating TAO patients in daily practice is also included. Conclusion: According to our experience, US examination of the orbit is an excellent and irreplaceable tool for timely TAO diagnosis and further disease monitoring. However, considerable examiner experience and detailed knowledge of the clinical and ultrasound manifestations of TAO are essential.

Computed tomography and magnetic resonance imaging of the orbit in the diagnosis and treatment of thyroid-associated orbitopathy - experience from practice. A Review.

The purpose is to acquaint readers with the contribution of imaging methods (IMs) of the orbit, specifically computed tomography (CT) and magnetic resonance imaging (MRI), in the diagnosis of thyroid-associated orbitopathy (TAO). Methods: IMs of the orbit are an indispensable accessory in the clinical and laboratory examination of TAO patients. The most frequently used and probably most accessible method is an ultrasound examination of the orbit (US), which, however, has a number of limitations. Other methods are CT and MRI. Based on the published knowledge implemented in our practice and several years of experience with the diagnosis and treatment of TAO patients, we would like to point out the benefits of CT and MRI in the given indications: visualisation of the extraocular muscles, assessment of disease activity, diagnosis of dysthyroid optic neuropathy and differential diagnosis of other pathologies in the orbit. Our recommendation for an ideal MRI protocol for disease activity evaluation is also included.  Conclusion: IMs play an irreplaceable role not only in the early diagnosis of TAO, but also in the monitoring of the disease and the response to the applied treatment. When choosing a suitable IM for this diagnosis, a number of factors must always be taken into account; not only availability, cost and burden for the patient, but especially the sensitivity and specificity of the given method for the diagnosis of TAO.

Comparison of Three Methods of Tonometry in Patients with Inactive Thyroid-Associated Orbitopathy.

INTRODUCTION: Intraocular pressure (IOP) measurement in patients with thyroid-associated orbitopathy (TAO) can be difficult and misleading, particularly in patients with diplopia and eye deviation (esotropia or hypotropia). However, when measuring IOP, it is also necessary to pay sufficient attention to TAO patients without diplopia in primary gaze direction and without motility disorder that might not be readily apparent. PURPOSE: The aim of this study was to evaluate the accuracy of measurement of intraocular pressure (IOP) using three different types of tonometers: the rebound tonometer (iCARE), the Goldmann applanation tonometer (GAT) and the non-contact airpuff tonometer (NCT) in patients with inactive TAO.  Materials and Methods: A total of 98 eyes of 49 adult patients with TAO were examined. The study group included 36 females and 13 males, with an age range of 19-70 years and a median age of 55.0. All the patients had evidence of thyroid disease,  a history of mild to moderate TAO, no clinical signs or symptoms of active disease, and no diplopia in direct gaze direction. In addition to a comprehensive eye examination, all the patients underwent measurement of intraocular pressure with three tonometers: NCT, iCARE, and GAT. The measurements with these three devices were compared. RESULTS: The mean IOP was 18.1 ± 2.4 mmHg (range 13-25 mmHg) with GAT, 22.3 ±5.0 mmHg (range 13-35 mmHg) with NCT, and 18.0 ±2.4 mmHg (range 13.3-26 mmHg) with iCARE. The mean difference between the GAT and iCARE measurements (using the Bland-Altman analysis) was -0.1 ±1.16 mmHg (limits of agreement -2.4 to 2.1). The mean difference between the GAT and NCT measurements was 4.2 ±3.6 mmHg (limits of agreement -2.8 to 11.2). The mean difference between the iCARE and NCT measurements was -4.3 ±3.7 mmHg (limits of agreement -11.6 to 2.9). No significant difference was found between GAT and iCARE (p = 1.000). However, there was a significant difference between GAT and NCT (p < 0.0001), as well as between iCARE and NCT (p < 0.0001).  Conclusions: In patients with TAO, NCT significantly overestimates IOP values compared to the GAT and ICare. By contrast, the iCARE rebound tonometer provides IOP measurements comparable to the gold standard GAT in these patients.

COMPUTER TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING OF THE ORBIT IN THE DIAGNOSIS AND TREATMENT OF THYROID-ASSOCIATED ORBITOPATHY - EXPERIENCE FROM PRACTICE. A REVIEW.

The purpose is to acquaint readers with the contribution of imaging methods (IMs) of the orbit, specifically computer tomography (CT) and magnetic resonance imaging (MRI), in the diagnosis of thyroid-associated orbitopathy (TAO). Methods: IMs of the orbit are an indispensable accessory in the clinical and laboratory examination of TAO patients. The most frequently used and probably most accessible method is an ultrasound examination of the orbit (US), which, however, has a number of limitations. Other methods are CT and MRI. Based on the published knowledge implemented in our practice and several years of experience with the diagnosis and treatment of TAO patients, we would like to point out the benefits of CT and MRI in the given indications: visualisation of the extraocular muscles, assessment of disease activity, diagnosis of dysthyroid optic neuropathy and differential diagnosis of other pathologies in the orbit. Our recommendation for an ideal MRI protocol for disease activity evaluation is also included. Conclusion: IMs play an irreplaceable role not only in the early diagnosis of TAO, but also in the monitoring of the disease and the response to the applied treatment. When choosing a suitable IM for this diagnosis, a number of factors must always be taken into account; not only availability, cost and burden for the patient, but especially the sensitivity and specificity of the given method for the diagnosis of TAO.

MRI in the assessment of thyroid-associated orbitopathy activity.

Management of patients with thyroid-associated orbitopathy (also called Graves' disease) is dependent on the assessment of the disease activity. Evaluation of disease activity is based on ophthalmological examination. Magnetic resonance imaging (MRI) is an auxiliary method that may help quantify the activity and is also helpful in obtaining anatomical information concerning muscle thickness, exophthalmos, or optic neuropathy. We present a review of MRI techniques of the orbits with emphasis on the evaluation of disease activity. The most convincing seems to be the group of T2-weighted techniques such as conventional T2 weighting, T2 relaxometry, and T2 mapping. Dynamic contrast-enhanced MRI is another promising method.

Non-arteritic anterior ischaemic optic neuropathy: treatment and risk factors.

AIM: To ascertain whether various therapeutic procedures in non-arteritic anterior ischaemic optic neuropathy (NAION) have an impact on the resulting visual acuity of the affected eye. To assess the prevalence of risk factors that accompany this disease according to the literature. METHODS: The retrospective study enrolled 55 eyes of 53 patients (41 men, 12 women) with an age range of 46 to 85 years (mean 64.9; median 64.0) who were hospitalized at the Department of Ophthalmology of the Faculty of Medicine and Dentistry and the University Hospital in Olomouc with the diagnosis of NAION between 2005 and 2016, and who received systemic treatment with intravenous vasodilators, either alone or in combination with intravenous corticosteroids. Central visual acuity (CVA) prior to treatment and immediately after its termination was evaluated. CVA was measured using the Snellen chart and is presented in decimal values. Using medical history data and medical records, the presence of systemic disease, namely hypertension, type 2 diabetes mellitus, and hypercholesterolaemia, was studied in these patients and evaluated for a possible association with NAION. RESULTS: In the group of patients who were treated with intravenous vasodilators, the resulting CVA improved by 0.083 on average. In the group of patients who, in addition to vasodilator therapy, also received treatment with corticosteroids, the resulting CVA improved by only 0.03 on average. Although there was a more prominent improvement in CVA in the group treated with intravenous vasodilators alone, this difference was not statistically significant. At least one risk factor was found in the vast majority of the patients (96%). Eighty percent of the patients had hypertension, 43.6% of them were treated for diabetes mellitus, and 72.7% of the patients took drugs for hypercholesterolaemia. A combination of all these conditions was found in 36.4% of the patients. The proportion of smokers and past smokers did not exceed that of non-smokers. CONCLUSION: The mean improvement in the resulting CVA in patients after systemic therapy with vasodilators alone was greater than in those treated with a combination of vasodilators and corticosteroids; however, this difference was not statistically significant. In most patients in the group, at least one systemic risk factor was noted, most frequently hypertension. The prevalence rate of systemic risk factors was comparable to that reported in the literature.

Current use of the automatic retinal oximetry. Review.

PURPOSE: To inform about possible use of the automatic retinal oximetry for the retinal oxygen saturation measurement in the eye and systemic diseases. METHODS: We performed a literature review dealing with issues of retinal oxygen saturation monitoring by dual non-invasive retinal oximetry Oxymap T1 (Oxymap ehf. Reykjavík, Iceland). RESULTS: We have found two main strains writing our paper on retinal oxygen saturation eye diseases. The first section concerns diseases created by having hypoxia as its main pathological factor  - for example diabetes mellitus and retinal vein occlusion. The second group deals with atrophy as the main pathological mechanism which is typical for decreasing retinal oxygen consumption - for example glaucoma or retinitis pigmentosa (the second one named is not included in our work). Oximetry in systemic diseases creates a relatively new chapter of this branch with a very big potential of interdisciplinary cooperation for the future. It is possible the cooperation will not only include diabetologists but also neurologists (for example, in diseases like sclerosis multiplex or Devics, Alzheimers and Parkinsons disease) and haematologists (retinal oxygen saturation changes in patients with different rheological attributes of blood). CONCLUSION: Retinal oxygen saturation measuring by automatic retinal oximetry is a relatively new method with scientifically confirmed high reproducibility of results. Currently it is the only experimental method with vast potentials not only in the realm of the possibility of observing eye diseases (diabetic retinopathy, retinal vein occlusion or glaucoma) but also in developing interdisciplinary cooperation with diabetologists, neurologists and haematologists.

[Ocular Surface Evaluation in Patients Treated with Prostaglandin Analogues Considering Preservative Agent]. / Hodnocení ocního povrchu u pacientu lécených analogy prostaglandinu s ohledem na obsazenou konzervacní látku.

PURPOSE: The aim of this study was to evaluate the ocular surface in patients treated with prostaglandin analogues considering contained preservative agent. METHODS: 60 patients with glaucoma or ocular hypertension treated with prostaglandin analogue monotherapy were enrolled in this observational study. 20 patients with glaucoma suspect or ocular hypertension without local or systemic glaucoma medication formed the control group. Demographic data and medical history were recorded for each participant. Patients filled in the Ocular surface disease index© (OSDI) questionnaire and underwent an ophthalmological examination including assessment of conjunctival hyperaemia according to Efron, tear film break up time (BUT) and fluorescein staining according to the Oxford grading scheme. Treated participants were divided into 3 groups according to the preservative contained in the currently used prostaglandin analogue: the preservative-free group (18 patients), the polyquaternium group (17 patients) and the benzalkonium chloride (BAK) group (25 patients). RESULTS: The control group had significantly lower fluorescein staining than the preservative-free group (p=0.001), the polyquaternium group (p=0.007) and the BAK group (p=0.002). The conjunctival hyperaemia was significantly lower in the preservative-free group compared to the polyquaternium group (p=0.011). There was no significant difference among the other groups. The difference neither in the OSDI score nor in the BUT was statistically important. CONCLUSION: This study confirmed that the ocular surface is worse in patients treated with prostaglandin analogue monotherapy than in people without glaucoma medication. A significant difference among treated patients depending on a preservative agent was not proved.Key words: benzalkonium chloride, glaucoma, ocular surface disease, preservatives, prostaglandin analogues.

[Automatic Retinal Oxymetry in Patients with Diabetic Retinopathy]. / Automatická retinální oxymetrie u pacientu s diabetickou retinopatií.

AIM: To determine if oxygen saturation in retinal vessels depends on the degree of diabetic retinopathy. MATERIAL AND METHODS: A prospective study comparing values of oxygen saturation in retinal arteries, veins, and arterio - venous (A-V) difference in healthy persons and in patients with diagnosed diabetes. The study included 114 eyes of 76 patients with diagnosed diabetes, and 57 eyes of 57 patients without diabetes as a control group. RESULTS: The average retinal arterial saturation in patients without diabetes was 96.5 ± 2.6 %, and increased in patients with severe non-proliferative or proliferative diabetic retinopathy to 100.5 ± 5.6 %. The average venous saturation in patients without diabetes was 62.3 ± 7.4 % and increased to 74,0 ± 7.2 % in patients with severe non-proliferative diabetic retinopathy. CONCLUSION: In patients with diabetic retinopathy, we confirmed the increase of hemoglobin oxygen saturation as in the arterial as in the venous blood in retinal vessels; and significant decrease of arterio-venous difference according to the severity of diabetic involvement was confirmed as well.Key words: automatic retinal oxymetry, diabetic retinopathy, oxygen saturation, Oxymap.

[ProVens® in the Therapy of Glaucoma and Ocular Hypertension]. / ProVens® v lécbe glaukomu a ocní hypertenze.

OBJECTIVE: To assess the effect of the ProVens® dietary supplement administration on intraocular pressure in patients with glaucoma and ocular hypertension. MATERIAL AND METHODS: The patients included in the trial were given the ProVens® dietary supplement once daily. One ProVens® tablet contains: 50 mg of maritime pine bark extract, 100 mg of green tea extract, and 3 mg of blueberry extract. The main ProVens® components are proanthocyanins from the bark of the maritime pine tree Pinus pinaster, polyphenols from green tea, and anthocyanins from blueberries. The total number of patients included in the trial was 46. Out of these, 35 patients were monitored for asymptomatic ocular hypertension and 11 patients for open-angle glaucoma treated with prostaglandin analogs. Intraocular pressure was measured by applanation tonometry in the beginning of the trial, after one month, and after three months of their inclusion in the trial, always at the same time of the day. RESULTS: In the group of patients with ocular hypertension, there was a statistically significant reduction in the intraocular pressure from the baseline values of 24.2 ± 2.1 mm Hg to 20.9 ± 2.5 mm Hg within the period of three months (p < 0.0001). In the group of patients with open-angle glaucoma, there was a statistically significant reduction of the intraocular pressure from the baseline values of 18.4 ± 3.2 mm Hg to 17.0 ± 3.1 mm Hg within the period of three months since the beginning of administration of the product (p = 0.022). When comparing both groups, we observed a significantly higher reduction in intraocular pressure (p = 0.0001) in the group of patients with ocular hypertension. In the whole group, no adverse effects were reported during the intake of this dietary supplement. CONCLUSION: Intake of the ProVens® dietary supplement containing proanthocyanins from the bark of the maritime pine tree Pinus pinaster together with a mixture of herbal antioxidants appears to be one of the methods of how to improve the control of intraocular pressure, particularly in patients with ocular hypertension. KEY WORDS: glaucoma, ocular hypertension, ProVens®, proanthocyanins, antioxidants, maritime pine bark extract.

[Extraocular muscle involvement in patients with thyroid-associated orbitopathy]. / Postizení okohybných svalu u pacientu s endokrinní orbitopatií

AIM: To determine the frequency of extraocular rectus muscle involvement in patients with thyroid-associated orbitopathy (TAO). MATERIALS AND METHODS: A total of 154 orbits of 77 adult patients (53 women and 24 men) with TAO aged from 18 to 81 years (median 49 years) were investigated. Only patients with clear signs of TAO and confirmed thyroid disease who had been referred to the Department of Ophthalmology of the Olomouc University Hospital from May 2007 to December 2012 were included. All patients underwent general ophthalmic examination and ultrasonographic and MRI examinations of the orbit. The largest short and long cross-sectional diameter for every rectus muscle was measured on MRI scans. Spearman correlation analysis was used to determine the correlations between the diameters of rectus muscles and exophthalmos values obtained. RESULTS: A positive moderate correlation (r = 0.514) was shown between the sum of short parameters of all rectus muscles and exophthalmos values. When compared with the normative values and taking gender into account, enlargement of the medial rectus muscle (RM) was found in 55.2 %, of the lateral rectus muscle (RL) in 33.8 %, the inferior rectus muscle (RI) in 57.1 %, and of the superior muscle group (RS) in 59.1 %. In the cases of single-muscle enlargement, the most frequently affected muscle was the RS (48.8 %), followed by the RI (31.7 %) and RM (19.5 %). No case of single-muscle enlargement of the RL was observed. In the cases of two-muscle enlargement, the RS was involved in 64.3 %, the RI and RM in 60.7 %, and the RL in 14.3 %. In the cases of three-muscle enlargement, the most frequently affected muscle was the RM (93.1 %), followed by the RI (86.2 %), RS (69%), and RL (51.7 %). CONCLUSION: Our study found that, in cases with single-muscle enlargement in patients with TAO, the vertical rectus muscles were most likely involved. On the other hand, in cases with multiple-muscle enlargement, the muscle most likely involved was the medial rectus muscle. In addition, the superior muscle group was noted to be affected more frequently than reported in the world literature. Key words: thyroid-associated orbitopathy, extraocular muscles, magnetic resonance imaging.

[The importance of angle kappa for centration of multifocal intraocular lenses]. / Význam úhlu kappa pro centraci multifokálních nitroocních cocek.

PURPOSE: To evaluate patient satisfaction with multifocal intraocular lens (MIOL) implants (AcrySof Restor) in relation to the size of angle kappa and precise centration of the MIOL. METHODS: Fifty-two eyes of 26 patients were included in this study. All patients underwent bilateral phacoemulsification and multifocal intraocular lens implantation (AcrySof Restor) from January 2008 to April 2010. Preoperative and postoperative examinations included slit lamp biomicroscopy, near and distance uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), contrast sensitivity and measurement of angle kappa. Precise centration of the IOL with respect to the centre of the pupil was evaluated postoperatively. Subjective photic phenomena were evaluated separately for each eye and the patients were asked to compare the perception between the right and left eye. RESULTS: Angle kappa was positive in all cases, ranging from +1° to +7°. The mean angle kappa was 2.78° and 2.10° in the right and left eye, respectively. The IOL was centred exactly to the centre of the pupil in 40 eyes. In twelve eyes there was a slight decentration of the IOL (3 nasal, 4 temporal, 2 superotemporal, 2 superior, 1 inferior). Different subjective perception of photic phenomena between the two eyes was recorded only in five patients. All these patients were among those with a decentred IOL. Temporal and superotemporal decentration of the IOL caused pronounced photic phenomena in five cases - in four cases there was a greater angle kappa of +3° to +4°. In one case of temporal decentration and a small angle kappa (+1°), the patient failed to observe a difference between both eyes. In the cases of inferior, superior and nasal decentration of the IOL, no difference between both eyes was seen. CONCLUSION: According to our results, temporal decentration of the IOL is associated with the greatest risk in multifocal IOL implantation, particularly in cases with a higher angle kappa. An evaluation of angle kappa should be a part of preoperative examination before MIOL implantation. Patients with a high angle kappa should be excluded because of a higher risk of postoperative photic phenomena. Key words: angle kappa, multifocal intraocular lens, photic phenomena.

[Conservative management options for thyroid disease induced diplopia]. / Konzervativní moznosti resení diplopie u pacientu s endokrinní orbitopatií

AIM: To focus on the conservative management options for diplopia in patients with thyroid ophthalmopathy in the active and in the "wait-for-operation" stage of the disease. To evaluate the degree of patient knowledge about the treatment options for diplopia and about different types of occlusion. To identify patient preferences when selecting from various management options. MATERIALS AND METHODS: This prospective study included patients with thyroid ophthalmopathy and disturbing diplopia in the primary gaze position who were referred for further treatment at the Department of Ophthalmology from January 2010 to June 2012. Twenty five patients (16 women and 9 men) were included for this study during the observation period. At the beginning, the degree of patient knowledge about the treatment options for diplopia and about different types of occlusion was assessed. Subsequently, all patients were informed in detail about different types of black and semi-translucent occlusion. After stabilization of diplopia, Fresnel prism and prism spectacle glasses were tested. At follow-up visits, patient preferences were evaluated. RESULTS: Twenty patients were initially informed about monocular patching options by their doctor. Only twelve patients received more specific recommendations on how to cover the eye; in all cases non-translucent plastic or tape patch was recommended. Only one patient used non-translucent occlusion in daily life; ten patients used it occasionally during static activities. None of the patients was informed about semi-translucent occlusion possibilities. At follow-up after two to four months, 19 patients used semi-translucent occlusion in daily life (18 used semi-translucent tape, one used frosted lens). Only one patient continued to use non-translucent occlusion. Five patients used no occlusion and closed one eye when necessary. CONCLUSION: Strabismus surgery in patients with thyroid ophthalmopathy is recommended in the inactive phase of the disease. For patients with diplopia it could be very difficult to overcome the active phase of the disease. In our study, the vast majority of patients in this phase preferred semi-translucent occlusion to non-translucent one.

[Efficacy and tolerability of preservative-free tafluprost 0.0015 % in the treatment of glaucoma and ocular hypertension]. / Úcinnost a snásenlivost tafluprostu 0,0015% bez konzervacních látek v lécbe glaukomu a ocní hypertenze.

AIM: The aim of the study was to evaluate the efficacy, safety and local tolerability of preservative-free tafluprost 0.0015% (Taflotan®) in patients with glaucoma and ocular hypertension. MATERIALS AND METHODS: Multicentric, prospective observation study was performed in the Czech Republic from October 2010 to April 2011. A total of 78 centers participated and 754 patients were included. After the doctors decision to start the treatment with Taflotan®, the patients demographic data, previous treatment, intraocular pressure and the reason for switching the medication were recorded. At the follow-up visit after 6-12 weeks, the intraocular pressure, local tolerability (a 5-level scale), the patients and doctors satisfaction (a 4-level scale), and the patients preference were recorded. RESULTS: Altogether, data of 496 patients were evaluated. The majority of them were women (64.9 %). The patients mean age was 58.5 years. The most common diagnosis was primary open angle glaucoma (79.2 %), followed by ocular hypertension (7.3 %), normal tension glaucoma (4.2 %), and pseudoexfoliation glaucoma (3.6 %). In 140 patients, tafluprost 0.0015% was the first antiglaucomatous medication started, 261 patients switched from another monotherapy, and 95 patients were treated with fixed- or nonfixed combinations before starting tafluprost 0.0015%. The most common reason for switching to Taflotan® was local intolerability to the current antiglaucomatous therapy (most often irritation of the eye and hyperemia). The intraocular pressure decreased significantly from 19.9 ± 4.5 mm Hg to 16.3 ± 3.0 mm Hg (p < 0.001). The subjective tolerability of the antiglaucomatous therapy improved rapidly, with 57.4 % of patients rating the tolerability of Taflotan® as "very good" and 34.5 % as "good". In addition, 94.4 % of patients and 96.0 % of ophthalmologists were "very satisfied" or "satisfied" with the treatment. At the final visit, 79.8 % of patients preferred Taflotan® to the previous treatment. CONCLUSION: Taflotan® significantly decreased the intraocular pressure. It was well tolerated even in patients with previous intolerability to another antiglaucomatous therapy, including prostaglandins. The patients and ophthalmologists satisfaction with Taflotan® was high.

[Floppy eyelid syndrome and obstructive sleep apnoea]. / Floppy eyelid syndrom a syndrom obstrukcní spánkové apnoe.

Floppy eyelid syndrome (FES) is a relatively rare condition of unknown aetiology, commonly described in association with other systemic conditions, particularly with obstructive sleep apnoea--OSA (the most frequent and most significant sleep-related breathing disorder in terms of morbidity and mortality). It is characterized by an extremely enlarged and floppy upper eyelid which can be very easily everted (often spontaneously during sleep). The laterality of the disease corresponds to the side the patient sleeps on. The patient may also present with upper lid ptosis, lash ptosis or trichiasis, lower lid ectropion, chronic papillary conjunctivitis, and chronic corneal disorders. The aim of this study is to report this syndrome, which is often overlooked in eye clinics, and to summarize our experience with its diagnosis and treatment. The correct and early diagnosis of FES may be a clue to the correct diagnosis of, at the time of FES diagnosis, unknown OSA.

[Adjustable versus non-adjustable sutures in strabismus surgery in patients with thyroid ophthalmopathy]. / Srovnání metody nastavitelných versus fixních stehu pri operaci strabismu u pacientu s endokrinní orbitopatií

AIM: To evaluate the results of strabismus surgery in patients with thyroid ophthalmopathy. To determine whether adjustable suture surgery is beneficial for these patients. MATERIALS AND METHODS: This study included patients who underwent strabismus surgery associated with thyroid ophthalmopathy from June 2010 to March 2012. During the observation period, 14 patients met the inclusion criteria. Seven patients underwent non-adjustable suture surgery (five women and two men) and seven patients underwent adjustable suture surgery (five women and two men). The patients mean age was 63 years. The preoperative ocular findings were stable for at least one year in all cases. All strabismus surgeries were performed by one surgeon. The postoperative results were recorded at follow-up visits after 1 week, 1 month, 3 months and 6 months. RESULTS: In the non-adjustable suture case series, three patients were satisfied with the results (including one with a compensatory head posture). Two patients required reoperation and two prismatic correction. In the adjustable suture case series, no reoperation or prismatic correction was needed. In this group, all the patients were satisfied with the results (including one with a compensatory head posture). CONCLUSION: Adjustable suture strabismus surgery in patients with thyroid ophthalmopathy proved to be beneficial. In our adjustable suture case series, there was a lower number of reoperations and prismatic corrections.