Adjustable Versus Non-adjustable Sutures in Strabismus Surgery in Patients with Thyroid Ophthalmopathy

Authors: M. Karhanová;  O. Vláčil;  M. Šín;  K. Marešová
Authors‘ workplace: Oční klinika LF UP a FN Olomouc, přednosta doc. MUDr. Jiří Řehák, CSc., FEBO
Published in: Čes. a slov. Oftal., 68, 2012, No. 5, p. 207-213
Category: Original Article

Předneseno na XX. výročním sjezdu České oftalmologické společnosti v Plzni, 21. 9. 2012


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.

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).

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.

Key words:
restrictive strabismus, thyroid ophthalmopathy, adjustable sutures, diplopia


1. Bartley, G.B., Fatourechi, V., Kadrmas, E.F. et al.: Chronology of Graves’ ophthalmopathy in an incidence cohort. Am J Ophthalmol, 1996; 121: 426–434.

2. Bishop, F., Doran, R.M.: Adjustable and non-adjustable strabismus surgery: a retrospective case-matched study. Strabismus, 2004; 12: 3–11.

3. Buckley, E.G.: Restrictive Strabismus. In: Plager DA, editor. Strabismus surgery: basic and advanced strategies. Oxford: Oxford University Press, 2004.

4. Currie, Z.I., Shipman, T., Burke, J.P.: Surgical correction of large-angle exotropia in adults. Eye(Lond), 2003; 17: 334–9.

5. Čmelo, J., Chynoranský, M., Podoba., J. et al: Endokrinná orbitopatia – epidemiologické súvislosti. Čes. a slov. Oftal., 2006; 62(6): 373–380.

6. Del Canto, A.J., Crow, S., Perry, J.D. et al.: Intraoperative relaxed muscle positioning technique for strabismus repair in thyroid eye disease. Ophthalmology, 2006; 113: 2324–2330.

7. Evans, D, Kennerdell, J.S.: Extraocular muscle surgery for dysthyroid myopathy. Am J Ophthalmol, 1983; 95: 767–771.

8. Ferková, S., Chynoranský, M., Podoba, J. et al.: Spolupráca oftalmológa a endokrinóloga při liečbě endokrinnej orbitopatie. Čes a slov Oftal, 2007; 63(2): 108-116.

9. Hatt, S.R., Leske, D.A., Kirgis, P.A. et al.: The effects of strabismus on quality of life in adults. Am J Ophthalmol, 2007; 144: 643–7.

10. Keech, R.V., Scott, W.E., Christensen L.E.: Adjustable suture strabismus surgery. J Pediatr Ophthalmol Strabismus, 1987; 24: 97–102.

11. Keech, R.V., Hecker, R.R.: Adjustable suture strabismus surgery for aquired vertical deviations. J Pediatr Ophthalmol Strabismus, 1988; 25: 159–63.

12. Kerr, N.: The role of thyroid eye disease and other factors in the overcorrection of hypotropia following unilateral adjustable suture recession of the inferior rectus (An American ophthalmological society thesis). Trans Am Ophthalmol Soc, 2011; 109: 168–200.

13. Krásný, J., Brunnerová, R., Syslová J. et al.: Desetiletý rozbor operací poruch motility na Oční klinice FNKV v Praze. Čes. a slov. Oftal., 2007; 63(4): 249–261.

14. Liláková, D., Hejcmanová, D., Nováková, D.: Vliv strabismu na kvalitu života dospělých. Čes a slov Oftal, 2003; 59(3): 184–187.

15. Lueder, G., T., Scott, W.E., Kutsche, P.J. et. al.: Long-term results of adjustable surgery for strabismus secondary to thyroid ophthalmopathy. Ophthalmology, 1992; 99: 993–7.

16. Nardi, M.: Squint surgery in TED – hints and fints, or why Gravesę patients are difficult patiens. Orbit, 2009; 28(4): 245–250.

17. Nguyen, V.T., Park, D.J.J., Levin, L. et al.: Correction of restricted extraocular muscle motility in surgical management of strabismus in Gravesę ophthalmopathy. Ophthalmology, 2002; 109: 384–388.

18. Pellarová, H., Autrata, R., Unčovská, E. et. al.: Výsledky chirurgie strabismu dospělých. Čes a slov Oftal, 2009; 65(6): 208–216.

19. Rajendram, R., Bunce, C., Adams, G. at al.: Smoking and strabismus surgery in patiens with thyroid eye disease. Ophthalmology, 2011; 118: 2493–2497.

20. Scott, W.E., Thalacker, J.A.: Diagnosis and treatment of thyroid myopathy. Ophthalmology, 1981; 88: 493–498.

21. Skov, C.M., Mazow, M.L.: Managing strabismus in endocrine eye disease. Can J Ophthalmol, 1984; 19: 269–274.

22. Sprunger, D.T., Helveston, E.M.: Progressive overcorrection after inferior rectus recession. J Pediatr Ophthalmol Strabismus, 1993; 30: 145–148.

23. Stan, M.N., Bahn, R.S.: Risk factors for development or deterioration of Gravesę ophthalmopathy. Thyroid, 2010; 20: 777-83.

24. Sundaram, V., Haridas, A..: Adjustable versus non-adjustable sutures for strabismus. Cochrane diabase Syst Rev, 2005; (1): CD004240.

25. Thorton, J., Kelly, S.P., Harrison, R.A. et al.: Cigarette smoking and thyroid eye disease: a systematic review. Eye, 2007; 21: 1135–45.

26. Tripathi, A., Haslett, R., Marsh, I.B. et al.: Strabismus surgery: adjustable sutures – god for all? Eye (Lond), 2003; 17, 739–42.

27. Wright, K.W.: Late overcorrection after inferior rectus recession. Ophthalmology, 1996; 103: 1503-1507.

28. Zhang, M.,S.,Hutchinson, A.K., Drack, A.V. et al.: Improved ocular alignment with adjustable sutures in adults undergoing strabismus surgery. Ophthalmology, 2012; 119: 396–402.

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account