Large Inferior Rectus Recession without Lower Eyelid Retraction in Thyroid Eye Disease

Objectives: In this study, a new technique that does not cause lower eyelid retraction in patients with excessive limitation of movement and vertical strabismus due to inferior rectus (IR) fibrosis in thyroid eye disease was introduced. Methods: There were six patients with their six eyes with their mid-term results.
Operation Technique: According to the deviation amount, a 7–14 mm length bovine pericardium (Tutopatch®) was inserted between the distal end of the tendon and the beginning of the muscle fibers, which are located between the tendon’s distal end and the tendon muscle junction to the IR with 6/0 non-absorbable suture.
Results: There were six cases with a mean 19.5±5.2 PD (PD: prism diopters) (14–26 PD) vertical deviation and severe up-gaze limitations with a mean −4.1±0.75. The post-operative vertical deviation was a mean of 3.5±1.22 PD, and the limitation of upgaze was a mean of −1.3±0.4.
Conclusion: This procedure provides effective results in reducing gaze limitation and vertical deviation in thyroid patients without causing any problems in the eyelids.

Keywords: Bovine pericardium, thyroid eye disease, vertical strabismus