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

Dong Cheol Lee,Se Youp Lee

doi:10.1186/s12886-017-0422-6

Dong Cheol Lee, Se Youp Lee

Open Access

https://doi.org/10.1186/s12886-017-0422-6

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Abstract

BackgroundSeveral 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.MethodsA 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.ResultsThe 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.ConclusionsModified 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.

Highlights

Several inferior oblique (IO) weakening methods exist for correction of superior oblique palsy (SOP)
Based on the method of Guemes and Wright [11], we investigated the effects of modified graded recession and anteriorization according to the degree of vertical deviation in the primary position at far distance as an objective method for evaluating the success of surgical outcomes without creating opposite vertical strabismus
From 2006 to 2015, surgical treatment for patients diagnosed with unilateral SOP with diplopia or head tilting involved modified graded recession and anteriorization in a step-by-step process

Summary

Introduction

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. 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. Clinical features include hypertropia in the paralyzed eye, increased vertical deviation upon adduction, and head tilt to the ipsilateral side. It is usually diagnosed in outpatient departments involved in maintenance of binocular vision.

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