Geriatric patients (age ≥ 65) are prone to complications after surgery and are at risk for severe
thyroid eye disease (TED). In this study, we aim to identify preoperative demographic and TED patterns associated with geriatric patients who underwent
decompression surgery, to examine the effect of age on postoperative
strabismus rates, and to identify factors that may contribute to postoperative
strabismus in the geriatric subgroup. We retrospectively reviewed patients who underwent thyroid-related orbital
decompression surgery at the Kellogg Eye Center, University of Michigan, between 1999 and 2014. Primary outcome was postoperative
strabismus requiring palliation with prisms and/or
strabismus surgery. Descriptive, univariate, and multivariable logistic regression analyses were used to define association of geriatric age with postoperative
strabismus and determine predictors of postoperative
strabismus. Of 241 patients, 41 (17.0%) were geriatric. They were less likely to undergo bilateral
decompression (P = 0.012), less likely to be current smokers at time of
decompression (P = 0.002), and more likely to have preoperative primary gaze
diplopia (P = 0.001). Postoperative
strabismus rates for geriatric patients (≥ 65 years of age), ages 50-65, 30-50, and < 30, were 73.2%, 41.3%, 31.9%, and 15.8%, respectively (P = 0.002). On multivariable analysis, geriatric age remained an independent risk factor for postoperative
strabismus when compared to each age group (P ≤ 0.001). Among geriatric patients in subgroup multivariable analysis, balanced as opposed to lateral wall
decompression (P = 0.038) and shorter TED duration (P = 0.031) were independently predictive of postoperative
strabismus.