scholarly journals Clinical Features of Excyclotorsion In The Non-Paretic Eye of Patients With Congenital Unilateral Superior Oblique Palsy

2021 ◽  
Author(s):  
Eun-Hyang Cha ◽  
Suk-Gyu Ha ◽  
Youngwoo Suh ◽  
Seung-Hyun Kim
Keyword(s):  
Clinical Features ◽  
Retrospective Review ◽  
Superior Oblique Palsy ◽  
Postoperative Results ◽  
Primary Position ◽  
The Mean ◽  
Fixation Preference ◽  
Group 16 ◽  
Superior Oblique

Abstract To investigate preoperative clinical features and postoperative results according to the correspondence between excyclotorsion and the paretic eye in patients with congenital unilateral superior oblique palsy (USOP). A retrospective review of medical charts was performed. The patients were divided into the accordance (preoperative fundus ocular excyclotorsion in the paretic eye) and discordance (preoperative ocular excyclotorsion in the non-paretic eye) groups. The degree of excyclotorsion (scale, 0–4) was measured. Age, sex, hypertropia at the primary position, fixation preference, inferior oblique overaction, and degree of excyclotorsion were measured at each visit. Ninety-eight patients were included in this study. There were 70 (71.4%) and 28 patients (28.6%) in the accordance and discordance groups, respectively. The mean age in the accordance and discordance groups was 9.2 ± 12.7 and 7.5 ± 8.9 years, respectively. Sixteen patients (22.9%) in the accordance group and 12 patients (42.9%) in the discordance group were aged under 2 years (p=0.04). A fixation preference for the paretic eye was observed in two (2.9%) and eight (28.6%) patients in the accordance and discordance groups, respectively (p < 0.01). The accordance group (2.3 ± 0.67) demonstrated a significantly higher degree of excyclotorsion than the discordance group (1.9 ± 0.64) (p = 0.03). The postoperative degree of excyclotorsion in the accordance group (0.14 ± 0.39) was lower than that in the discordance group (0.28 ± 0.71) (p = 0.01). The prevalence of residual postoperative excyclotorsion (>1) in the discordance group was significantly higher (14 patients, 50%) than that in the accordance group (16 patients, 22.9%) (p = 0.01).Twenty-eight percent of the patients with congenital USOP demonstrated excyclotorsion in the non-paretic eye. Preoperative discordance between excyclotorsion and the paretic eye was observed in patients who were under 2 years of age and preferred fixation of the paretic eye. The postoperative degree of excyclotorsion was significantly lower in the accordance group.

scholarly journals Clinical Features of Excyclotorsion in the Non-Paretic Eye of Patients with Congenital Unilateral Superior Oblique Palsy

2021 ◽  
Author(s):  
Eun-Hyang Cha ◽  
Suk-Gyu Ha ◽  
Youngwoo Suh ◽  
Seung-Hyun Kim
Keyword(s):  
Clinical Features ◽  
Retrospective Review ◽  
Group 14 ◽  
Superior Oblique Palsy ◽  
Postoperative Results ◽  
Primary Position ◽  
Fixation Preference ◽  
Group 16 ◽  
Superior Oblique

Abstract Background To investigate preoperative clinical features and postoperative results according to the correspondence between excyclotorsion and the paretic eye in patients with congenital unilateral superior oblique palsy (USOP).MethodsA retrospective review of medical charts was performed. The patients were divided into the accordance (ocular excyclotorsion in the paretic eye) and discordance (ocular excyclotorsion in the non-paretic eye) groups. The degree of excyclotorsion (scale, 0–4) was measured. Age, sex, hypertropia at the primary position, fixation preference, inferior oblique overaction, and degree of excyclotorsion were measured.ResultsNinety-eight patients were included in this study. There were 70 (71.4%) and 28 patients (28.6%) in the accordance and discordance groups. Sixteen patients (22.9%) in the accordance group and 12 patients (42.9%) in the discordance group were aged under 2 years (p = 0.04). A fixation preference of the paretic eye was observed in 2 (2.9%) and 8 (28.6%) patients in the accordance and discordance groups (p < 0.01). The postoperative degree of excyclotorsion in the accordance group (0.14 ± 0.39) was lower than that in the discordance group (0.28 ± 0.71) (p = 0.01). The residual postoperative excyclotorsion (>1) in the discordance group were observed in the discordance group (14 patients, 50%) and accordance group (16 patients, 22.9%) (p = 0.01).Conclusion Preoperative discordance between excyclotorsion and the paretic eye was observed in patients who were under 2 years of age and preferred fixation of the paretic eye. The postoperative degree of excyclotorsion was lower in the accordance group.

scholarly journals The efficacy of superior oblique posterior tenectomy in the treatment of A-pattern exotropia without ocular intorsion: A retrospective study

2019 ◽  
Author(s):  
Yan Wei ◽  
Ling-Yan Dong ◽  
Xiao-li Kang ◽  
Pei-quan Zhao
Keyword(s):  
Rectus Muscle ◽  
Ocular Motility ◽  
Ocular Torsion ◽  
Primary Position ◽  
Horizontal Alignment ◽  
Pattern Deviation ◽  
The Mean ◽  
Fundus Photographs ◽  
Cover Test ◽  
Superior Oblique

Abstract Background: Superior oblique weakening is a common method to treat A-pattern strabismus. This study aims to evaluate the surgical results of the bilateral superior oblique posterior tenectomy procedure to treat A-pattern strabismus patients who had bilateral superior oblique overaction without objective ocular intorsion. Methods: The records of 18 consecutive patients who underwent surgery of superior oblique posterior tentomy close to its insertion with superior oblique overaction (SOOA)-associated A-pattern strabismus between September 1, 2015 and August 31, 2018 were retrospectively reviewed. Ocular alignment, objective torsion, A-pattern and ocular motility were assessed. Ocular alignment was measured in the primary position, 25° upgaze, and 25° downgaze using the prism bar cover test, and torsion was measured using fundus photographs. Results: A total of 18 patients (mean age: 15 years; 6 female, 12 male) underwent bilateral superior oblique posterior tenectomy and simultaneous horizontal rectus muscle surgery were included. The mean preoperative A-pattern deviation was 15 PD and the mean postoperative A-pattern deviation was 2.25 PD with a mean reduction of 12.75 PD. The mean preoperative superior oblique overaction was 2.28 and the mean postoperative superior oblique overaction was 0.43 with a mean reduction of 1.85. There was no significant correlation between the ocular torsional, vertical and horizontal alignment change and the superior oblique posterior tenectomy procedure. Conclusions: Superior oblique posterior tenectomy surgery selectively improved the A-pattern and superior oblique overaction but not affect the primary position vertical and horizontal deviation, as well as the ocular torsion. It is an effective procedure to treat the mild to moderate superior oblique overaction (SOOA)-associated A pattern strabismus without ocular intorsion.

scholarly journals The efficacy of superior oblique posterior tenotomy in the treatment of A-pattern strabismus without ocular intorsion: A retrospective study

2019 ◽  
Author(s):  
Yan Wei ◽  
Ling-Yan Dong ◽  
Xiao-li Kang
Keyword(s):  
Rectus Muscle ◽  
Ocular Motility ◽  
Ocular Torsion ◽  
Primary Position ◽  
Horizontal Alignment ◽  
Pattern Deviation ◽  
The Mean ◽  
Fundus Photographs ◽  
Cover Test ◽  
Superior Oblique

Abstract Background: Superior oblique weakening is a common method to treat A-pattern strabismus. This study aim to evaluate the surgical results of superior oblique posterior tenotomy procedures to treat A-pattern strabismus patients who had bilateral superior oblique overaction without ocular objective intorsion.Methods: The records of 18 consecutive patients who underwent surgery of superior oblique posterior tenotomy close to its insertion with superior oblique overaction (SOOA)-associated A-pattern strabismus between September 1, 2015 and August 31, 2018 were retrospectively reviewed. Ocular alignment, objective torsion, A-pattern and ocular motility were assessed. Ocular alignment was measured in the primary position, 25° upgaze, and 25° downgaze using the prism bar cover test, and torsion was measured using fundus photographs. Results: A total of 18 patients (mean age: 15 years; 6 female, 12 male) underwent bilateral superior oblique posterior tenotomy and simultaneous horizontal rectus muscle surgery were included. The mean preoperative A-pattern deviation was 15 PD and the mean postoperative A-pattern deviation was 2.25 PD with a mean reduction of 12.75 PD. The mean preoperative superior oblique overaction was 2.28 and the mean postoperative superior oblique overaction was 0.43 with a mean reduction of 1.85. There was no significant correlation between the ocular torsional, vertical and horizontal alignment change and the superior oblique posterior tenotomy procedure. Conclusions: Superior oblique posterior tenotomy surgery selectively improved the A-pattern and superior oblique overaction but not affect the primary position vertical and horizontal deviation, as well as the ocular torsion. So it is an effective procedure to treat the mild to moderate superior oblique overaction (SOOA)-associated A pattern strabismus without ocular intorsion.

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.

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.

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 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.

scholarly journals The efficacy of superior oblique posterior tenotomy in the treatment of A-pattern strabismus without ocular intorsion: A retrospective study

2020 ◽  
Author(s):  
Yan Wei ◽  
Ling-Yan Dong ◽  
Pei-quan Zhao ◽  
Xiao-li Kang
Keyword(s):  
Rectus Muscle ◽  
Ocular Motility ◽  
Ocular Torsion ◽  
Vertical Alignment ◽  
Primary Position ◽  
Pattern Deviation ◽  
The Mean ◽  
Fundus Photographs ◽  
Cover Test ◽  
Superior Oblique

Abstract Background: Superior oblique weakening is a common method to treat A-pattern strabismus. This study aims to evaluate the surgical results of the bilateral superior oblique posterior tenectomy procedure to treat A-pattern strabismus patients who had bilateral superior oblique overaction without objective ocular intorsion. Methods: The records of 18 consecutive patients who underwent surgery of superior oblique posterior tenectomy close to its insertion with superior oblique overaction (SOOA)-associated A-pattern strabismus between September 1, 2015 and August 31, 2018 were retrospectively reviewed. Ocular alignment, objective torsion, A-pattern and ocular motility were assessed. Ocular alignment was measured in the primary position, 25° upgaze, and 25° downgaze using the prism bar cover test, and torsion was measured using fundus photographs. Results: A total of 18 patients (mean age: 15 years; 6 female, 12 male) underwent bilateral superior oblique posterior tenectomy and simultaneous horizontal rectus muscle surgery were included. The mean preoperative A-pattern deviation was 15 PD and the mean postoperative A-pattern deviation was 2.25 PD with a mean reduction of 12.75 PD. The mean preoperative superior oblique overaction was 2.28 and the mean postoperative superior oblique overaction was 0.43 with a mean reduction of 1.85. There was no significant correlation between the ocular torsional, vertical alignment change and the superior oblique posterior tenectomy procedure. Conclusions: Superior oblique posterior tenectomy surgery selectively improved the A-pattern and superior oblique overaction but not affect the primary position vertical deviation, as well as the ocular torsion. It is an effective procedure to treat the mild to moderate superior oblique overaction associated A pattern strabismus without ocular intorsion.

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