Skip to main content
SpringerLink
Log in

Postoperative residual vertical deviation affects quality of life in Asian patients with thyroid-associated ophthalmopathy (Graves ophthalmopathy)

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the treatment effect of strabismus surgery for Graves ophthalmopathy in an ethnic Chinese population.

Study design

A prospective clinical study.

Methods

Thirty-one patients with Graves ophthalmopathy who had undergone strabismus surgery at National Taiwan University Hospital between 2012 and 2013 were consecutively recruited. The subjective outcome was evaluated using the Graves’ Ophthalmopathy Quality-of-Life (GO-QoL) questionnaire, and the ocular deviation was measured preoperatively and postoperatively by use of a prism cover test.

Results

The GO-QoL scores for visual functioning and appearance improved significantly after surgery (preoperative scores 32.6 ± 19.9 and 43.8 ± 26.4, postoperative scores 55.2 ± 24.4 and 54.1 ± 27.6, respectively; P < .05). Motor success was achieved in 61.3% of the patients, and their postoperative visual scores were higher (61.5 ± 22.5) than the scores of those who experienced motor failure (45.3 ± 26.8, P = .048). The postoperative visual function scores showed a negative correlation with the residual vertical deviation (R2 = 0.546, P = .040). A higher increase in GO-QoL visual scores and a lower residual vertical deviation in downgaze were achieved among patients without previous decompression surgery. Our surgical methods resulted in a motor success rate of 76.5% for the correction of vertical deviation.

Conclusion

GO-QoL scores and ocular deviation improved significantly after strabismus surgery. Precise correction of vertical deviation was of greater importance than horizontal deviation for visual function scores. Our surgical methods were effective for the correction of vertical deviation in Graves ophthalmopathy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data sharing Statement

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Terwee CB, Gerding MN, Dekker FW, Prummel MF, Wiersinga WM. Development of a disease specific quality of life questionnaire for patients with Graves’ ophthalmopathy: the GO-QOL. Br J Ophthalmol. 1998;82:773–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Terwee CB, Gerding MN, Dekker FW, Prummel MF, van der Pol JP, Wiersinga WM. Test-retest reliability of the GO-QOL: a disease-specific quality of life questionnaire for patients with Graves’ ophthalmopathy. J Clin Epidemiol. 1999;52:875–84.

    Article  CAS  PubMed  Google Scholar 

  3. Terwee CB, Dekker FW, Mourits MP, Gerding MN, Baldeschi L, Kalmann R, et al. Interpretation and validity of changes in scores on the Graves’ ophthalmopathy quality of life questionnaire (GO-QOL) after different treatments. Clin Endocrinol (Oxf). 2001;54:391–8.

    Article  CAS  PubMed  Google Scholar 

  4. Terwee CB, Wakelkamp I, Tan S, Dekker F, Prummel MF, Wiersinga W. Long-term effects of Graves’ ophthalmopathy on health-related quality of life. Eur J Endocrinol. 2002;146:751–7.

    Article  CAS  PubMed  Google Scholar 

  5. Nasr E, Khater S, Nehme-Nasr D, Azoury F, Jambart S. Corticosteroids and radiotherapy in the treatment of Graves’ ophthalmopathy. J Med Liban. 2010;58:86–90.

    PubMed  Google Scholar 

  6. Cheng AM, Wei YH, Tighe S, Sheha H, Liao SL. Long-term outcomes of orbital fat decompression in Graves’ orbitopathy. Br J Ophthalmol. 2018;102:69–73.

    Article  PubMed  Google Scholar 

  7. European Group on Graves’ Orbitopathy (EUGOGO), Mourits MP, Bijl H, Altea MA, Baldeschi L, Boboridis K, Currò N, et al. Outcome of orbital decompression for disfiguring proptosis in patients with Graves’ orbitopathy using various surgical procedures. Br J Ophthalmol. 2009;93:1518–23.

    Article  Google Scholar 

  8. Prummel MF, Terwee CB, Gerding MN, Baldeschi L, Mourits MP, Blank L, et al. A randomized controlled trial of orbital radiotherapy versus sham irradiation in patients with mild Graves’ ophthalmopathy. J Clin Endocrinol Metab. 2004;89:15–20.

    Article  CAS  PubMed  Google Scholar 

  9. Lin IC, Lee CC, Liao SL. Assessing quality of life in taiwanese patients with Graves’ ophthalmopathy. J Formos Med Assoc. 2015;114:1047–54.

    Article  PubMed  Google Scholar 

  10. Farid M, Roch-Levecq AC, Levi L, Brody BL, Granet DB, Kikkawa DO. Psychological disturbance in Graves’ ophthalmopathy. Arch Ophthalmol. 2005;123:491–6.

    Article  PubMed  Google Scholar 

  11. Yeatts RP. Quality of life in patients with Graves’ ophthalmopathy. Trans Am Ophthalmol Soc. 2005;103:368–411.

    PubMed  PubMed Central  Google Scholar 

  12. Coulter I, Frewin S, Krassas GE, Perros P. Psychological implications of Graves’ Orbitopathy. Eur J Endocrinol. 2007;157:127–31.

    Article  CAS  PubMed  Google Scholar 

  13. Garrity JA, Fatourechi V, Bergstralh EJ, Bartley GB, Beatty CW, DeSanto LW, et al. Results of transantral orbital decompression in 428 patients with severe Graves’ ophthalmopathy. Am J Ophthalmol. 1993;15:116:533–47.

    Article  Google Scholar 

  14. Goldberg RA, Perry JD, Hortaleza V, Tong JT. Strabismus after balanced medial plus lateral wall versus lateral wall only orbital decompression for dysthyroid orbitopathy. Ophthalmic Plast Reconstr Surg. 2000;16:271–7.

    Article  CAS  PubMed  Google Scholar 

  15. Ben Simon GJ, Syed HM, Lee S, Wang DY, Schwarcz RM, McCann JD, et al. Strabismus after deep lateral wall orbital decompression in thyroid-related orbitopathy patients using automated Hess screen. Ophthalmology. 2006;113:1050–5.

    Article  PubMed  Google Scholar 

  16. Sasim IV, Berendschot TT, van Isterdael C, Mourits MP. Planning health care for patients with Graves’ orbitopathy. Graefes Arch Clin Exp Ophthalmol. 2008;246:1315–21.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jellema HM, Saeed P, Mombaerts I, Dolman PJ, Garrity J, Kazim M, et al. Objective and subjective outcomes of strabismus surgery in Graves’ orbitopathy: a prospective multicentre study. Acta Ophthalmol. 2017;95:386–91.

    Article  PubMed  Google Scholar 

  18. Jellema HM, Merckel-Timmer E, Kloos R, Saeed P, Mourits MP. Quality of life improves after strabismus surgery in patients with Graves’ orbitopathy. Eur J Endocrinol. 2014;170:785–9.

    Article  CAS  PubMed  Google Scholar 

  19. Liao SL, Wei YH, Chuang AYC. The role of rectus muscle myectomy in the management of large-angle strabismus for Graves’ ophthalmopathy. Eye (Lond). 2017;31:1027–33.

    Article  CAS  PubMed  Google Scholar 

  20. Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clinical activity score as a guide in the management of patients with Graves’ ophthalmopathy. Clin Endocrinol. 1997;47:9–14.

    Article  CAS  Google Scholar 

  21. Honglertnapakul W, Cavuoto KM, McKeown CA, Capó H. Surgical treatment of strabismus in thyroid eye disease: characteristics, dose-response, and outcomes. J AAPOS. 2020;24:72e1–7.

    Article  Google Scholar 

  22. Bradley EA, Sloan JA, Novotny PJ, Garrity JA, Woog JJ, West SK. Evaluation of the National Eye Institute visual function questionnaire in Graves’ ophthalmopathy. Ophthalmology. 2006;113:1450–4.

    Article  PubMed  Google Scholar 

  23. Bharadwaj SR, Hoenig MP, Sivaramakrishnan VC, Karthikeyan B, Simonian D, Mau K, et al. Variation of binocular-vertical fusion amplitude with convergence. Invest Ophthalmol Vis Sci. 2007;48:1592–600.

    Article  PubMed  Google Scholar 

  24. Lee JKS, Hsieh C, Wei YH, Liao SL. The impact of orbital bony or fat decompression on the outcome of strabismus surgery in patients with Graves’ ophthalmopathy. J Formos Med Assoc. 2019;118:387–94.

    Article  PubMed  Google Scholar 

  25. Kim MH, Park KA, Oh SY. The effect of previous orbital decompression on results of strabismus surgery in patients with Graves’ ophthalmopathy. J AAPOS. 2013;17:188–91.

    Article  PubMed  Google Scholar 

  26. Akbari MR, Mirmohammadsadeghi A, Mahmoudzadeh R, Veisi A. Management of thyroid eye disease-related strabismus. J Curr Ophthalmol. 2020;23:32:1–13.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan

    Ying-Yi Chen, Yi-Hsuan Wei & Shu-Lang Liao

  2. Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan

    Ying-Yi Chen

  3. Department of Ophthalmology, Sijhih Cathay General Hospital, New Taipei City, Taiwan

    Ying-Yi Chen

  4. Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Ying-Yi Chen & Yi-Hsuan Wei

Authors
  1. Ying-Yi Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yi-Hsuan Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shu-Lang Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shu-Lang Liao.

Ethics declarations

Conflict of interest

Y.Y. Chen, None; Y. H. Wei, None; S. L. Liao, None.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Corresponding Author: Shu-Lang Liao

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, YY., Wei, YH. & Liao, SL. Postoperative residual vertical deviation affects quality of life in Asian patients with thyroid-associated ophthalmopathy (Graves ophthalmopathy). Jpn J Ophthalmol 67, 326–334 (2023). https://doi.org/10.1007/s10384-023-00990-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10384-023-00990-z

Keywords

Search

Navigation