Behandlung des Strabismus sursoadductorius (congenital superior oblique palsy) im Kindesalter

Abstract

The aim of this study was to evaluate the effect of inferior oblique muscle recession (IOR) in children with pure unilateral strabismus sursoadductorius (so-called congenital superior oblique palsy, CSOP) operated before age 11 years. A retrospective study of IOR in children with unilateral CSOP and surgery before age 11 years was undertaken. In most cases, recession and anteroposition of the anterior part of the inferior oblique tendon next to the lateral edge of the inferior rectus muscle was performed without fixation of the posterior part of the tendon. Main outcome measures were change in abnormal head tilt, change in vertical deviation, both in straight and contralateral side gaze, and evaluation of squint angles. Between 1997 and 2007, 36 consecutive children (aged 2 -10 years; 27 boys, 9 girls) received IOR for unilateral CSOP. The dose of IOR ranged between 6 and 12 mm. Vertical deviation in straight and contralateral gaze was reduced from median 5° (range 0 - 11°) and 12° (3 - 20°) to 0° (-2 - 8°) and 1° (-5 - 13°), respectively. Abnormal head tilt towards the contralateral shoulder was reduced from median 10° (0 - 20°) to 0° (-2,5 - 10°). Three children (8 %) received further extraocular muscle surgery within 2 years, one because of persistent hyperdeviation, and two because of consecutive hypodeviation of the operated eye. The results indicate that IOR with fixation of only the anterior part of the inferior oblique to the sclera is an effective treatment for strabismus sursoadductorius/CSOP in children. Undercorrection into a residual, well compensated stage is a satisfying result. Both overcorrection and elevation deficiency were rare.