Surgical treatment of diplopia in Graves' Orbitopathy patients

This thesis addresses several aspects of the surgical treatment of diplopia in patients with Graves’ Orbitopathy (GO). We evaluated retrospectively the surgical outcome of different types of surgery on eye muscles to correct the diplopia. Each operated muscle seems to have its own dose-effect response, e.g. the effect of 1 mm recession of the muscle on the correction of the eye position (strabismus). As soon as 3 months after surgery, the outcome is stable and if needed further treatment can be planned. We also studied if tools to measure different aspects of strabismus were interchangeable, especially the tools to evaluate outcome on ductions and cyclodeviation. The results of this study helped to set up success criteria for this type of treatment. Additionally, a literature review was performed to argue the details of success criteria. Two studies about the effect on strabismus surgery on patient’s quality of life (QoL) showed a significant increase on both subscales of the QoL i.e. on both visual functioning and appearance questions after the treatment. With the presented proposal for success criteria given in this thesis future multicenter studies can become more constrained to evaluate all aspects regarding outcome in GO-patients undergoing strabismus surgery with the overall aim to improve the patient’s QoL as much as possible.