{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:18:02Z","timestamp":1769771882917,"version":"3.49.0"},"reference-count":46,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Patients with severe ocular motility restriction and\/or large angle strabismus due to Graves' orbitopathy (GO) cannot be adequately addressed with conventional strabismus surgery using large muscle recessions. Muscle tendon elongation surgery, using a spacer of bovine pericardium (Tutopatch\u00ae) has emerged as a valuable alternative. The purpose of this study was to assess the long\u2010term outcome of muscle elongation surgery in patients with GO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective observational cohort study in three University centres was conducted. All GO patients requiring strabismus surgery with elongation material of one or more rectus muscles were included. One week preoperatively and 3 and 6\u2009months postoperatively, ophthalmic and orthoptic examinations were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty\u2010five patients were enrolled in the study. The mean length of spacer used was 8.2\u2009mm (range 4\u201313\u2009mm). Tendon elongation was performed on 15 inferior rectus muscles, 33 medial rectus muscles and 9 superior rectus muscles. The field of BSV improved from 0 points [IQR 0\u20130] preoperatively to 80 points [IQR 6\u201392] postoperatively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). QoL for functional questions changed from 47 points [IQR 31\u201363] preoperatively to 78 points [IQR 73\u2013100] postoperatively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009&lt;0.001). HADS level of anxiety and depression remained below the cut\u2010off score of 15 points (preoperative 11.5 and postoperative 5.7 points).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using the muscle tendon elongation technique with Tutopatch\u00ae in GO patients with severely restricted strabismus, 3\u2009months after surgery a stable large field of BSV can be achieved with associated improvement of the QoL. It is a safe and effective alternative to large muscle recessions for restricted muscle.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aos.17545","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T07:54:22Z","timestamp":1751961262000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Muscle tendon elongation with bovine pericardium (Tutopatch\u00ae) in patients with Graves\u2019 orbitopathy; a prospective, observational, multicentre study"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0435-096X","authenticated-orcid":false,"given":"H. M.","family":"Jellema","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Orbital Center, Amsterdam UMC University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Oeverhaus","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University Duisburg Essen  Essen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Eckstein","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University Duisburg Essen  Essen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I.","family":"Mombaerts","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Neurosciences, Faculty of Medicine Catholic University Leuven  Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. J. H. 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