Clinical factors underlying a single surgery or repetitive surgeries to treat superior oblique muscle palsy.

Kana Aoba,Kayoko Hasebe,Ichiro Hamasaki,Toshihiko Matsuo

doi:10.1186/s40064-015-0945-3

Kana Aoba, Kayoko Hasebe + Show 2 more

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https://doi.org/10.1186/s40064-015-0945-3

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Abstract

The purpose of this study is to know clinical factors underlying either a single surgery or repetitive surgeries, required to treat superior oblique muscle palsy. Retrospective review was made on 246 consecutive patients with idiopathic (n = 212) or acquired (n = 34) superior oblique muscle palsy who underwent surgeries in 8 years at one institution. Idiopathic palsy included congenital and decompensated palsies while acquired palsy included traumatic and ischemic palsies. Clinical factors, compared between groups with a single surgery (n = 203) and two or more surgeries (n = 43), were surgical methods, sex, age at surgery, horizontal, vertical, and cyclotorsional deviations, and stereopsis at near fixation. Inferior oblique muscle recession on paretic side was chosen in about 60% of the single-surgery and repetitive-surgery group as an initial surgery, followed by inferior rectus muscle recession on non-paretic side. The age at surgery was significantly older, vertical and cyclotorsional deviations were significantly larger in the repetitive-surgery group, compared with the single-surgery group (P = 0.01, P < 0.001, P = 0.02, Mann–Whitney U-test, respectively). The 95% confidence interval of vertical deviations was 15–17 prism diopters in the single-surgery group and 23–28 prism diopters in the repetitive surgery group. Significant differences in vertical deviations were replicated also in subgroups of patients with either idiopathic or acquired palsy. In conclusions, the 95% confidence interval of vertical deviations, determined by alternate prism and cover test, would be used as a common benchmark for predicting either a single surgery or repetitive surgeries, required to treat idiopathic and acquired superior oblique muscle palsy, in the process of obtaining the informed consent.

Highlights

Superior oblique muscle palsy is a most frequent ocular motor abnormality, encountered in ophthalmic practice
The acquired superior oblique muscle palsy presents clinical manifestations such as diplopia, especially in the downward gaze, and a smaller range of vertical fusion amplitudes, which are different from the manifestations in the idiopathic palsy
In overall 246 patients with either idiopathic or acquired superior oblique muscle palsy, inferior oblique muscle recession on the paretic side was chosen in about 60% of both the single-surgery group (n = 203) and the repetitivesurgery group (n = 43) as an initial surgery (Table 1), followed by inferior rectus muscle recession on the non

Summary

Introduction

Superior oblique muscle palsy is a most frequent ocular motor abnormality, encountered in ophthalmic practice. The palsy is presented as either congenital or acquired. Congenital superior oblique muscle palsy is found in childhood usually with abnormal head posture, compensatory head tilt to the contralateral non-paretic side. The congenital palsy is sometimes diagnosed only in adulthood as decompensated palsy when diplopia. Acquired superior oblique muscle palsy is the acquired trochlear nerve palsy which develops abruptly with blunt head trauma or vascular ischemic accidents. The trochlear nerve palsy has a high chance for spontaneous recovery usually in one to three months. The acquired superior oblique muscle palsy presents clinical manifestations such as diplopia, especially in the downward gaze, and a smaller range of vertical fusion amplitudes, which are different from the manifestations in the idiopathic palsy

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