Adding Tenon’s recession to strabismus surgery for TED yields high success rates

In this retrospective review, investigators evaluated the improvement in ocular alignment among patients who underwent horizontal strabismus surgery with Tenon’s recession for thyroid eye disease (TED).

Study design

The single-surgeon study included 38 patients with TED and restrictive horizontal strabismus who had unilateral or bilateral medial rectus recession to relieve diplopia. All patients underwent recession of the Tenon layer, which was performed from a peri-limbal incision by sharply dissecting this layer from conjunctiva, allowing it to retract into the orbit. Adjustable sutures were used to recess the medial rectus muscle, typically on the non-dominant eye in bilateral surgeries.

Success was defined as the ability to fuse at distance and near with 10 prism diopters or less of correction. Additional outcomes measures included reoperation rate and alignment in eccentric gazes.

Outcomes

The overall success rate was 87% and the reoperation rate was 7.9%. Esotropia improved between 25 to 28 prism diopters from baseline in eccentric gaze.

Limitations

The study did not directly compare this technique with other techniques. Single binocular field of vision was not measured.  

Clinical significance

Recession of Tenon's layer during adjustable medial rectus muscle recession for TED-related esotropia results in relatively low reoperation rates and very good alignment in primary, reading and eccentric gaze.