Skip to main content

  • Predicting Strabismus Reoperations in TED

    By Lynda Seminara
    Selected by Richard K. Parrish II, MD
    Add to My Bookmarks

    Journal Highlights

    American Journal of Ophthalmology, June 2022

    Download PDF

    To better understand the risk factors and frequency of strabismus reop­eration in patients with thyroid eye disease (TED), Hwang et al. explored a national claims database in which the average time since the first strabismus surgery was five years. They noted that many patients had a reoperation within a year. The number of muscles involved in the first surgery was the strongest predictor of reoperation and the inter­val to reoperation: More muscles raised the reoperation risk and shortened the time between surgeries. Patients who required surgery on vertical and hori­zontal muscles had the highest reopera­tion rate (30.8%).

    For this population-based review, the authors searched the Clinformatics Data Mart to identify adults with newly diagnosed TED who had at least one strabismus surgery between 2003 and 2019. They collected detailed informa­tion, including demographics, time from TED diagnosis to initial strabis­mus surgery, fixation method, time until reoperation, and the muscles involved in the original surgery.

    Altogether, 448 cases were assessed. Most patients were white (78%) and female (68%). The mean age at initial surgery was 62.7 for those with reoper­ation and 63.3 for those without. The mean follow-up time was 5.4 years, and approximately 25% of patients needed reoperation during this period. The mean time to first reoperation was 1.04 ± 1.63 years. Reoperation rates were 19.5%, 24.2%, and 30.8% if the original surgery entailed just vertical muscles, just horizontal muscles, or both types of muscles (respectively); the corre­sponding mean numbers of muscles were 1.82, 1.42, and 3.15. In terms of risk factors, the main analysis showed just one independent predictor of reoperation: higher number of muscles operated on initially (odds ratio, 1.27; p = .03). After adjustment for demo­graphic and other variables, more muscles also coincided with shorter times to first reoperation (hazard ratio, 1.22; p = .03).

    The authors noted that even though reoperation rates were relatively stable during the study timeline, the risk of reoperation rose from about 20% if one or two muscles were affected to more than 40% if at least four muscles were involved, suggesting that disease sever­ity may correlate with risk. They hope the findings for this nationwide sample will facilitate treatment decisions and improve patient education.

    The original article can be found here.