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Smoking and strabismus surgery in patients with thyroid eye disease

Rajendram, Rathie, Bunce, Catey, Adams, Gillian G. W., Dayan, Colin Mark and Rose, Geoffrey E. 2011. Smoking and strabismus surgery in patients with thyroid eye disease. Ophthalmology 118 (12) , pp. 2493-2497. 10.1016/j.ophtha.2011.06.003

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Abstract

Objective To investigate the relationship between smoking status at presentation and the use of strabismus surgery in the management of patients with thyroid eye disease. Design Retrospective review of a noncomparative series of patients with thyroid eye disease. Participants All patients with thyroid eye disease under the care of a single consultant at Moorfields Eye Hospital between 1997 and 2002 (inclusive). Methods Retrospective review of clinical case notes. Main Outcome Measures Survival analysis of patients in cohort and the frequency of strabismus surgery in relation to smoking status at ophthalmic presentation. A subanalysis of patients who underwent orbital decompression and those that did not was undertaken. Results Of 501 patients seen during the study period, 425 (85%) of 501 sets of notes were available for review, and initial smoking status was recorded for 89% (378/425) of patients, of whom approximately one half (196/378; 52%) were active smokers. Of the smokers, 51 (26%) of 196 underwent strabismussurgery, compared with only 19 (14%) of 138 nonsmokers at presentation. When adjusted for age, the hazards ratio of having strabismus surgery during management for smokers at presentation versus nonactive smokers was 2.19. In the group who did not undergo orbital decompression, this hazard ratio increased to 4.86. Conclusions Within this thyroid eye disease cohort, the proportion of smokers at presentation was much larger than that of the general population. There was an increased use of strabismus surgery in active smokers at presentation than in nonactive smokers. This finding was independent of the orbital decompression surgery. The results are consistent with those of previous reports of more severe thyroid eye disease in smokers and raise the possibility that smoking cessation early in the disease may reduce the severity of the changes and the number of rehabilitative strabismus operations needed. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article. Thyroideyedisease is an autoimmune condition associated with inflammation of the eyelids, conjunctiva, eye muscles, and orbital fat. Extraocular muscle edema, commonly asymmetrical, often leads to restriction of eye movements, and any resulting diplopia can be both highly disabling and cosmetically disturbing. Strabismussurgery, performed almost exclusively during the inactive phase of the condition, can help to reduce these problems, although the results of surgery are less predictable than in patients without thyroideyedisease and are associated with a higher reoperation rate.1 The actual strabismussurgery in such patients also can be more difficult because of postinflammatory changes in the epibulbar tissues and restriction of access resulting from muscular contracture from (sometimes gross) fibrosis2; therefore, the ultimate goal remains to reduce any factors that may lead to the development of muscle disease. Smoking repeatedly has been reported to be associated with more severe thyroideyedisease. This responds less well to treatment in the active phase of the disease. [3], [4], [5], [6], [7] and [8] However, because strabismussurgery generally is performed later, in the inactive phase of the disease, it may be that smoking has less of an effect on the need for strabismussurgery. This article reports an investigation into the effect of smoking status (at presentation) on the frequency of strabismussurgery performed in a very large cohort of patients with this condition.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Systems Immunity Research Institute (SIURI)
Subjects: R Medicine > RE Ophthalmology
Publisher: Elsevier
ISSN: 0161-6420
Last Modified: 04 Jun 2017 03:46
URI: http://orca.cf.ac.uk/id/eprint/26431

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