Effect of modified graded recession and anteriorization on unilateral superior oblique palsy: a retrospective study

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Abstract

Background

Several inferior oblique (IO) weakening methods exist for correction of superior oblique palsy (SOP). A previously reported method involved recession and anteriorization according to IO overaction (IOOA) grade, which might be subjective and cause upgaze limitation and opposite vertical strabismus. Therefore, this study attempted to examine the efficacy of modified graded recession and anteriorization of the IO muscle in correction of unilateral SOP without resulting in upgaze limitation or opposite vertical strabismus.

Methods

A total of 26 patients (male, 16; female, 10; age: 3–40 years) with SOP and head tilt or diplopia underwent modified graded recession and anteriorization. Patients were grouped by the position at which the IO muscle was attached inferior/temporal to the lateral border of the inferior rectus (IR) as follows: (1) 7.0/2.0 mm (4 patients), (2) 6.0/2.0 mm (3 patients), (3) 5.0/2.0 mm (3 patients), (4) 4.0/2.0 mm (11 patients), (5) 3.0/0.0 mm (2 patients), and (6) 2.0/0.0 mm (3 patients). Recession and anteriorization were matched to vertical deviation in the primary position at far distance. Remaining diplopia, head tilt, vertical deviation (≤3 prism diopter (PD), excellent; 4–7 PD, good; and ≥ 8 PD, poor), upgaze limitation, and opposite vertical strabismus were evaluated.

Results

The average pre and postoperative 1-year vertical deviation angles in the primary position at far distance were 15.0 ± 5.6 PD and 1.2 ± 2.0 PD, respectively. At 1 year post-surgery, the vertical deviation angles were reduced by 6.8–21.0 PD from those at baseline. Few patients exhibited remaining head tilt, diplopia, upgaze limitation, or opposite vertical strabismus. Correction of hypertropia was excellent in 22 and good in 4 patients.

Conclusions

Modified graded recession and anteriorization of the IO muscle is an effective surgical method for treating unilateral SOP. It exhibits good results and reduces the incidence of opposite vertical strabismus.

Electronic supplementary material

The online version of this article (doi:10.1186/s12886-017-0422-6) contains supplementary material, which is available to authorized users.

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Most cited references 20

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Superior oblique paralysis. A review of 270 cases.

Benjamin C Y Wong, Donna E. Murray, Albert E G K von dem Borne (1986)

In 270 patients with superior oblique paralyses treated between 1973 and 1984, congenital and traumatic causes were most frequent, and one fourth of all traumatic cases had bilateral involvement. Among the diagnostic features distinguishing bilateral from unilateral paralysis were a right hypertropia in left gaze and left hypertropia in right gaze, and a positive Bielschowsky test on tilting the head toward either shoulder. However, absence of either sign did not exclude bilateral paralysis. Large excyclotropia and a V-pattern esotropia are suggestive of but not diagnostic for bilateral paralysis. Complaints about cyclotropia are limited to acquired paralysis. Cyclotropia in the normal eye, head tilt toward the involved side, or absence of any abnormal head posture limits the diagnostic value of these associated signs. Overshoot of the contralateral superior oblique occurred in 19% of the patients and is thought to be caused by contracture of the ipsilateral superior rectus muscle. Surgical treatment in 112 patients resulted in an 85% cure rate with an average of 1.45 operations per patient.

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Outcome of surgical management of superior oblique palsy: a study of 123 cases.

W Feuer, Walter Laviña, R M Siatkowski … (1997)

To determine the outcome of the surgical management of superior oblique palsy at our institution. Retrospective review of 123 patients who underwent surgical correction of superior oblique paresis at Bascom Palmer Eye Institute from 1976 to 1996. Subject-Patients: 67% were male and 33% female. The mean age at surgery was 30.5 years (range, 2-78 years). Etiologies of the pareses were trauma (34%), congenital (33%), and acquired/non-traumatic (33%). The mean angle of preoperative vertical deviation in primary gaze was 14.0 delta (range, 0-45 delta). 109/123 (89%) patients underwent single muscle surgery. Of these 109, 57 had single oblique muscle surgery: a superior oblique tuck in 34/57 (60%); an inferior oblique weakening procedure in 22/57 (38%); and a Harada-Ito procedure in 1/57 (2%). The other 14 patients (11%) had bilateral surgery. The final postoperative vertical deviation in primary gaze was < or =3 PD in 60% of patients and < or =7 PD in 80%. The mean change in primary position vertical deviation postoperatively was 10.4 PD for distance and 13.0 PD for near. An "excellent" outcome (final vertical deviation &le3 PD in primary and reading gazes) was achieved most frequently in those patients with congenital pareses and isolated oblique muscle surgery. Clinically significant Brown's Syndrome occurred in 43/72 (60%) of those cases who had undergone a superior oblique tuck. The incidence of Brown's Syndrome was unrelated to tuck size. Reoperation was three times more likely to be necessary in traumatic cases than in congenital cases (35.0% vs 11.9%, p=0.02). Based on these results we recommend oblique muscle surgery as the initial procedure to correct superior oblique palsy when appropriate.

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Anterior transposition of the inferior oblique.

R Elliott, S Nankin (2016)

An analysis of the technique and the results of anterior transposition compared to standard recession surgery on the inferior oblique muscle has been presented. Several potential advantages of anterior transposition have been suggested. Certainly, more data are required to corroborate the conclusion of this study and to more clearly delineate the appropriate place for anterior transposition of the inferior oblique in the armamentarium of the strabismus surgeon.

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Author and article information

Contributors

Dong Cheol Lee: tking33@naver.com

Se Youp Lee: + (82) 010-7477-7720 , + (82) 053-250-7720 , lsy3379@dsmc.or.kr

Journal

Journal ID (nlm-ta): BMC Ophthalmol

Journal ID (iso-abbrev): BMC Ophthalmol

Title: BMC Ophthalmology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2415

Publication date (Electronic): 14 March 2017

Publication date PMC-release: 14 March 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 27

Affiliations

Department of Ophthalmology, Keimyung University Dongsan Medical Center, Keimyung University school of Medicine, Daegu, 41931 South Korea

Article

Publisher ID: 422

DOI: 10.1186/s12886-017-0422-6

PMC ID: 5351157

PubMed ID: 28292276

SO-VID: 39ef305c-c67a-45e3-96e7-27471f675dcc

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 7 December 2016

Date accepted : 7 March 2017

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ScienceOpen disciplines: Ophthalmology & Optometry

Keywords: modified graded recession,anteriorization,inferior oblique muscle,unilateral superior oblique palsy

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ScienceOpen disciplines: Ophthalmology & Optometry

Keywords: modified graded recession, anteriorization, inferior oblique muscle, unilateral superior oblique palsy

Effect of modified graded recession and anteriorization on unilateral superior oblique palsy: a retrospective study

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Abstract

Background

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Karger: Ophthalmology

Most cited references 20

Superior oblique paralysis. A review of 270 cases.

Outcome of surgical management of superior oblique palsy: a study of 123 cases.

Anterior transposition of the inferior oblique.

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