scholarly journals Decompensated Superior Oblique Palsy Secondary to Bilateral Nutritional Optic Neuropathy Following Bariatric Surgery

2021 ◽  
pp. 1008-1013
Author(s):  
Eleanor Nche ◽  
Ravid Ben-Avi ◽  
Ari Shemesh ◽  
Joshua M. Kruger
Keyword(s):  
Bariatric Surgery ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Visual Fields ◽  
Head Tilt ◽  
Nutritional Supplements ◽  
Nutritional Deficiencies ◽  
Superior Oblique Palsy ◽  
Primary Position ◽  
Superior Oblique

Optic neuropathy can occur secondary to nutritional deficiencies in patients who have undergone bariatric surgery. We present a unique case of a 39-year-old man, claiming to be generally healthy, who presented with intermittent vertical diplopia and bilateral decreased vision in each eye. Visual acuity was 6/18 in the right eye and 6/12 in the left eye. Ishihara testing was defective for both eyes. Automated visual fields showed a severe generalized reduction in sensitivity in both eyes. The patient had a left head tilt and a right intermittent hypertropia of 30 prism diopters in primary position. CT of the orbits revealed a right superior oblique of small caliber. On further questioning, the patient admitted to a history of bariatric surgery 7 years prior to presentation with failure to take any nutritional supplements. Blood work demonstrated deficiencies in folate, thiamine, and copper. Within 6 months of initiating nutritional supplements, the vision in each eye was markedly improved and the diplopia resolved. There was an associated normalization of thiamine and copper, but folate levels remained low. We believe that the nutritional deficiency caused a bilateral optic neuropathy and the resulting vision loss precipitated a manifestation of a congenital superior oblique palsy that had previously just been a phoria. The case emphasizes the importance of considering occult sensory etiologies of acquired strabismus.

Inferior oblique recession associated to partial temporal inferior rectus recession in unilateral congenital superior oblique palsy

2021 ◽  
pp. 112067212199766
Author(s):  
Barbara Burgos-Blasco ◽  
Elena Hernandez-Garcia ◽  
Carlos Llorente-La-Orden ◽  
Rosario Gomez-de-Liaño
Keyword(s):  
Head Tilt ◽  
Contralateral Side ◽  
Superior Oblique Palsy ◽  
Inferior Rectus ◽  
Primary Position ◽  
Female Age ◽  
Vertical Deviation ◽  
Inferior Oblique Recession ◽  
Age Range ◽  
Superior Oblique

Purpose: To evaluate the effectiveness of inferior oblique recession with contralateral partial temporal inferior rectus recession in patients with decompensated congenital unilateral superior oblique palsy (SOP) in correcting moderate vertical deviations in primary position. Methods: The medical records of patients with SOP who underwent inferior oblique recession with contralateral partial temporal inferior rectus recession were reviewed retrospectively. Vertical deviation in primary position, subjective torsion, diplopia, residual deviation, and the deviation decrease were evaluated. Results: Four patients (three males and one female, age range 29–56 years) with congenital unilateral SOP and mean vertical deviation of 21.0 ± 5.3PD (range 14–25D) in primary position were included. Mean correction of hypertropia in primary position with this technique was 15.5 ± 5.3PD (range 10–20PD). The mean hypertropia on gaze to the contralateral side changed from 30.0 ± 10.8D before surgery to 9.3 ± 7.9D after surgery. Torsion had a mean change of 4.8° of incyclodeviation. Preoperatively, all patients had head tilt and diplopia, which was resolved in all but one patient, who will need surgery. Patients were followed an average of 18 months. No adverse events were reported in any subjects. Conclusion: When performing recession of inferior oblique muscles in SOP associated to a full recession of the contralateral inferior rectus, there is a risk of overcorrection in those with moderate angles. Performing a partial recession in the contralateral inferior rectus eye corrected up to 20PD in primary position in our series, reducing this risk.

scholarly journals Post-bariatric surgery nutritional follow-up in primary care: a population-based cohort study

2020 ◽  
pp. bjgp20X714161
Author(s):  
Helen Parretti ◽  
Anuradhaa Subramanian ◽  
Nicola Adderley ◽  
Abbott Sally ◽  
Tahrani Abd ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Primary Care ◽  
Cohort Study ◽  
Nutritional Supplements ◽  
Nutritional Deficiencies ◽  
Future Research ◽  
Blood Tests ◽  
Weight Measurement ◽  
Post Surgery

Abstract Background: Bariatric surgery is the most effective treatment for severe obesity. However, without recommended follow-up it has long-term risks. Aim: To investigate whether nutritional and weight monitoring in primary care meets current clinical guidance, post-specialist discharge. Design and setting: Retrospective cohort study. Primary care practices contributing to IQVIA Medical Research Data (IMRD)–UK (1/1/2000-17/1/2018). Methods: Participants were adults who had had bariatric surgery with a minimum of three years’ follow-up post-surgery as this study focused on patients discharged from specialist care (at 2yrs post-surgery). Outcomes were annual proportion of patients from 2yrs post-surgery with a record of recommended nutritional screening blood tests, weight measurement and prescription of nutritional supplements, and proportions with nutritional deficiencies based on blood tests. Results: 3137 participants were included and median follow-up post-surgery was 5.7 (4.2-7.6) years. 45-59% had an annual weight measurement. The greatest proportions of patients with a record of annual nutritional blood tests were for tests routinely conducted in primary care, e.g. recorded haemoglobin measurement varied between 44.9% (n=629/1400) and 61.2% (n=653/1067). Annual proportions of blood tests specific to bariatric surgery were low, e.g. recorded copper measurement varied between 1.2% (n=10/818) and 1.5% (n=16/1067) (where recommended). Results indicated that the most common deficiency was anemia. Annual proportions of patients with prescriptions for recommended nutritional supplements were low. Conclusions: Our study suggests that bariatric surgery patients are not receiving recommended nutritional monitoring post-specialist discharge. GPs and patients should be supported to engage with follow-up care. Future research should aim to understand reasons underpinning our findings.

scholarly journals The Neurological Complications of Nutritional Deficiency following Bariatric Surgery

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Danielle A. Becker ◽  
Laura J. Balcer ◽  
Steven L. Galetta
Keyword(s):  
Bariatric Surgery ◽  
Vitamin D ◽  
Vitamin E ◽  
Optic Neuropathy ◽  
Neurological Complications ◽  
Nutritional Deficiencies ◽  
Vitamin B ◽  
Neurologic Complications ◽  
The Us ◽  
Prevalence Of Obesity

Neurologic complications of bariatric surgery have become increasingly recognized with the rising numbers of procedures and the increasing prevalence of obesity in the US. Deficits are most commonly seen with thiamine, vitamin B12, folate, vitamin D, vitamin E, and copper deficiencies. The neurological findings observed with these nutritional deficiencies are variable and include encephalopathy, optic neuropathy, myelopathy, polyradiculoneuropathy, and polyneuropathy. We review the neurological complications of bariatric surgery and emphasize that these findings may vary based on the specific type of bariatric surgery and time elapsed from the procedure.

Perinatal Head Tilt in Congenital Superior Oblique Palsy

2009 ◽  
Vol 29 (1) ◽  
pp. 76-77 ◽  
Author(s):  
Michael C Brodsky ◽  
Virginia Karlsson
Keyword(s):  
Head Tilt ◽  
Superior Oblique Palsy ◽  
Superior Oblique

A single inferior rectus muscle surgery for treatment of congenital superior oblique palsy with small deviation in primary position

2021 ◽  
pp. 112067212110143
Author(s):  
Lijuan Huang ◽  
Yuyu Wu ◽  
Ningdong Li
Keyword(s):  
Rectus Muscle ◽  
Head Position ◽  
Superior Oblique Palsy ◽  
Inferior Rectus ◽  
Primary Position ◽  
Class V ◽  
Abnormal Head ◽  
Inferior Rectus Muscle ◽  
Superior Oblique

Purpose: To evaluate outcomes of one muscle surgery for treatment of congenital superior oblique palsy (SOP) with Knapp Class V. Methods: Medical records were retrospectively reviewed for the patients with the congenital SOP type V who underwent surgical treatment through one muscle surgery between July 2015 and September 2020. The surgical procedure was resection-recession on the contralateral inferior rectus muscle of the hypertrophic or paretic eye. Vertical alignment at nine cardinal gaze positions, and resolution of the abnormal head posture were evaluated pre- and postoperatively. The follow-up was scheduled regularly at postoperative day 1, 1 week, 1 month, and followed by 2-month intervals until 18 months. Results: Twelve patients were included in this study, with a mean age of 6.4 years (range from 3 to 10 years). The mean follow-up period was 10.5 months after surgery (range from 6 to 18 months). The average vertical deviation at primary position was 6.33△ ± 2.93△ preoperatively and 0.75△ ± 1.14△ postoperatively ( p < 0.05). The average vertical deviation at downgaze was 23.33△ ± 4.75△ preoperatively and 1.92△ ± 1.62△ postoperatively ( p < 0.05). All patients had an abnormal head position preoperatively. Postoperative results indicated that the patients’ abnormal head position had been improved significantly. Conclusions: The surgical procedure of resection-recession on a single inferior rectus muscle is a successful intervention for the correction of superior oblique palsy (SOP) with Knapp Class V.

Superior oblique split tendon elongation for Brown’s syndrome: Long-term outcomes

2021 ◽  
pp. 112067212199105
Author(s):  
Biana Dubinsky-Pertzov ◽  
Eran Pras ◽  
Yair Morad
Keyword(s):  
Intraoperative Complications ◽  
Long Term Outcomes ◽  
Superior Oblique Palsy ◽  
Primary Position ◽  
Age At Surgery ◽  
Tendon Elongation ◽  
Acceptable Outcome ◽  
Superior Oblique

Purpose:To report the outcomes of superior oblique split tendon elongation in Brown’s syndrome.Methods:Charts of 17 consecutive Brown’s syndrome patients who underwent superior oblique split tendon elongation were reviewed and clinical data regarding preoperative, intraoperative, and postoperative data were collected.Results:About 17 eyes of 17 children with congenital Brown’s syndrome underwent superior oblique split tendon elongation between January 2012 and March 2020 by a single surgeon. Mean age at surgery was 5.47 ± 2.82 (range 1.50–13.2). Eight (47.1%) were female. Preoperative deficit of elevation in adduction was −4 in all children. At the end of surgery, all eyes were freely elevated on adduction, on forced duction test. Mean follow-up time of 26.24 ± 11.22 (range 11–53) months. In 15 of 17 children (88.2%), motility improved, orthotropia in primary position was achieved, and head posture eliminated ( p < 0.001). Superior oblique palsy occurred in two children, who after reoperation, achieved an acceptable outcome. No intraoperative complications were recorded.Conclusion:The superior oblique split tendon elongation procedure is a useful surgical technique with stable and satisfying outcomes for the treatment of severe congenital Brown’s syndrome.

scholarly journals Paradoxical head tilt in unilateral traumatic superior oblique palsy

2017 ◽  
Vol 29 (3) ◽  
pp. 221-223
Author(s):  
Mohammad Reza Akbari ◽  
Reza Bayat ◽  
Arash Mirmohammadsadeghi ◽  
Reza Mirshahi
Keyword(s):  
Head Tilt ◽  
Superior Oblique Palsy ◽  
Superior Oblique
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