June 5, 2020 Conference
Partial Tendon Recession for Small-Angle Vertical Strabismus
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Dr. Catherine Choi, Tufts Medical Center (Presenter)
There are few reliable treatment options for small vertical deviations in patients who prefer to be spectacle-free. A partial tendon recession procedure is one surgical option, and this study evaluated its effectiveness in correcting small vertical deviations. This study is an institutional retrospective consecutive series of 56 procedures in 47 patients. Change in vertical deviation in primary position was evaluated, as was prism diopter change per millimeter of partial tendon recession. Separate analyses were performed to compare outcomes in patients with thyroid eye disease and those who underwent re-operations on the same muscle. The average preoperative vertical deviation was 4.3 ± 1.8 prism diopters (PD) of deviation and the average postoperative vertical deviation was 0.0 ± 2.3 PD, p < 0.0001. There was an average of 1.5 prism diopters of change per millimeter of partial tendon recession. 62% of post-operative patients were orthophoric in the overall sample. 60% of thyroid patients were orthophoric post-operatively versus 63% of non-thyroid patients. 29% of the re-operated patients were orthophoric post-operatively versus 67% of non-re-operated patients. 82% of patients had no vertical diplopia after one procedure and did not require a second surgery or prism correction in glasses. Preoperative vertical deviation had a more significant correlation with postoperative alignment than did the actual amount of surgical recession. Our results also suggest outcomes in re-operated muscles are less predictable. There was no significant difference in post-operative outcome between patients with thyroid eye disease and those without. In this sample of patients, a partial tendon recession effectively corrected small vertical deviations and is a treatment option to consider in patients who prefer spectacle independence.