The surgical management of strabismus with large angle in patients with Graves’ ophthalmopathy

Background Strabismus with large deviation in Graves’ ophthalmopathy is relatively common in developing countries, such as China. However, little information is available in the literature on this condition. We report here our surgical results of strabismus with large deviation in Graves’ ophthalmopathy. Patients and methods The surgical management of strabismus in 27 patients with Graves’ ophthalmopathy with large angle (≥25°) were retrospectively analyzed. The strabismus surgery included recession or free tenotomy of involved rectus muscle, recession of rectus plus resection of ipsilateral antagonist, and recession of rectus plus recession of contralateral antagonist. The patients were followed up for an average of 1.2 years. Results Among 27 patients, 17 were male and 10 were female, with their age ranging from 28 to 68 years old (mean: 51.9 years). There were 12 cases with excellent results, 10 with good results, 3 with fair results, and 2 with poor results. Only one surgery was required in all cases except three who needed re-operation. Based on the rectus muscles involved, just one rectus muscle recession combined with traction suture could correct the strabismus with large angle in 20 patients; two muscles were required in 9 patients and three in 1 patient. Four patients had surgical overcorrection of strabismus. Eight patients had complicated eyelid retraction postoperatively. Conclusions The surgical management of strabismus with large deviation in patients with Graves’ ophthalmopathy was remarkably good. Just one rectus muscle recession combined with traction suture could correct the large angle strabismus in 74% (20/27) of cases. The choice of surgical procedure and some special attention in performing surgery are discussed.