Long-term outcomes of using intraoperative relaxed muscle positioning technique in thyroid eye disease
Reviewed by Lauren Hepworth

The authors present a retrospective case review of consecutive patients undergoing ocular muscle surgery by one ophthalmologist using the intraoperative relaxed muscle positioning (IRMP) technique for thyroid eye disease (TED)-associated strabismus over a 23-year period. The following data were extracted from the records: demographics, thyroid-related orbitopathy treatment received, primary gaze strabismus measurement, ocular motility surgery details, including muscle, amount and complications. The last documented visit was used to determine outcome, with outcomes graded into three categories (excellent, good and poor) which are described in detail. A total of 129 cases were included in the study. Around half had previously had orbital decompression. The majority of cases (94%) were judged as good or excellent. Diplopia was resolved either without (82%) or with (18%) the support of prism after a single surgery. Additional surgery was performed on 26% of cases. Cases which required additional surgery were not more likely to have had previous orbital decompression. However, the size of the horizontal deviation was greater for those requiring additional surgery. Three-quarters of cases undergoing a second procedure had a successful outcome (no diplopia in primary or reading positions). The authors acknowledge the retrospective methodology of the study as a limitation, specifically with regard to missing data around a key confounding variable of smoking status. This study supports the success of the IRMP technique for large angle strabismus in TED, combined horizontal and vertical deviation and in cases of disease reactivation.

Outcomes of the intraoperative relaxed muscle positioning technique in strabismus surgery for thyroid eye disease.
Muste JC, Wang K, Hwang CJ, et al.
JOURNAL OF THE AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2023;27:340.