Strabismus surgery, an operation to correct misaligned eyes, has shown promising outcomes in patients with thyroid eye disease who had previously undergone teprotumumab therapy, according to a recent study.
The research was a retrospective case series carried out across seven academic medical centers. The data from 28 patients who had undergone strabismus surgery between August 2016 and April 2023 was reviewed. The study considered a successful operation as one that provided relief from diplopia (double vision). This could be through the use of prism glasses or alterations in head position for those who didn’t find relief from these measures before surgery. Also included in the success category were patients with intermittent double vision who saw functional and symptomatic improvement post-surgery.
The average time from the last teprotumumab treatment to strabismus surgery was 7.5 months. The study found that 57% of patients were free of double vision after just one surgical procedure. Three patients who chose to have a second operation (with an average deviation of 12 prism diopters [PD] horizontally and 10.3 PD vertically before the first procedure) underwent an adjustable suture procedure. They achieved an average postoperative deviation of 0 PD horizontally and 5 PD vertically. Patients who had undergone orbital decompression before strabismus surgery were analyzed separately; 45% of these patients were free from double vision after just one operation.
However, the study had its limitations. Due to the retrospective nature of the data collection, there was a lack of consistent long-term follow-up data and no protocols for determining ocular rotations or forced duction testing. Furthermore, the time between the last teprotumumab treatment and strabismus surgery was short, making it challenging to predict success in patients with a longer interval between treatment and surgery. Lastly, the study population was relatively small.
Despite these limitations, the study has significant clinical implications. It was found that patients with thyroid eye disease treated with teprotumumab had good strabismus surgery success rates. This information can be beneficial for clinicians when advising their patients about what to expect from strabismus surgery. Although the surgeons who performed the operations reported that some patients’ extraocular muscles were tighter than those of patients not treated with teprotumumab, they also found the opposite in some cases.
The study’s financial disclosures reveal that Dr. Nikisha Richards has financial relationships with Genentech and Horizon Therapeutics in the capacity of a consultant/advisor.
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