Abstract
To evaluate three superior oblique surgical weakening procedures for correcting A-pattern strabismus: tenectomy, superior oblique hang-back recession, and that involving the use of superior oblique suture spacers. The inclusion criteria were A-pattern strabismus ≥10Δ and horizontal deviation ≥10Δ, with no other ocular abnormality and a follow-up period of ≥6 months. The 24 patients (mean age, 16.3 ± 8.1 years; mean postoperative follow-up, 9.63 ± 3.11 months) were randomly divided into three groups of 8 patients each. Sigmascan® Pro 5.0 software was used to measure the degree of torsion pre- and postoperatively. Preoperatively, the mean angles of A-pattern deviation were 19.33Δ° ± 3.53Δ° (tenectomy group), 15.71Δ° ± 1.11Δ° (hang-back recession group), and 14.62Δ° ± 1.18Δ° (suture spacers group); these values did not differ significantly. At the final follow-up examination, the mean angles of A-pattern deviation were 4.67Δ° ± 0.67Δ° (tenectomy group), 6.29Δ° ± 1.48Δ° (hang-back recession group), and 4.38Δ° ± 1.03Δ° (suture spacers group), with no statistically significant difference in the correction in A-pattern strabismus among the three groups. Preoperatively, the mean torsional angles were +5.4° ± 3.9° (tenectomy group), +5.6° ± 4.9° (hang-back recession group), and +6.0° ± 3.3° (suture spacers group); these values did not differ significantly. At the final follow-up examination, the mean torsional angles were + 0.3° ± 5.6° (tenectomy group), +0.5° ± 4.6° (hang-back recession group), and +0.2° ± 5.2° (suture spacers group), with no statistically significant difference in the intorsion correction among the three groups. All three superior oblique weakening procedures were effective for correcting A-pattern strabismus and fundus intorsion.
Highlights
There is evidence that superior oblique overaction (SOOA) can induce A-pattern strabismus, which can affect an individual’s reading position and impact his or her quality of life[1,2,3]
No statistically significant difference in the correction in the A-pattern strabismus was observed among the three groups (p=1.12, p=1.65, the suture spacers group compared with the tenectomy group, the hang-back recession group)
The mean torsional angles were +5.4° ± 3.9° in the tenectomy group, +5.6° ± 4.9° (0.4° to +13.3°) in the hang-back recession group, and +6.0° ± 3.3° (0.0° to +11.3°) in the suture spacers group; these values did not differ significantly (p=1.51, p=1.21, the suture spacers group compared with the tenectomy group, the hang-back recession group)
Summary
There is evidence that superior oblique overaction (SOOA) can induce A-pattern strabismus, which can affect an individual’s reading position and impact his or her quality of life[1,2,3]. A-pattern strabismus can be corrected by surgery to weaken the superior oblique (SO) muscles. This is a challenging surgical procedure, requiring a thorough knowledge of anatomy, extensive experience, and appropriate preoperative decisions, and its outcome can be unpredictable. The SO muscles can be weakened in various ways, including by split tendon elongation, tenectomy, posterior tenotomy, using silicone tendon expanders or tendon suture spacers, and hang-back recession of the muscles[1,3,9]. Expanders and hang-back recession have been shown to be useful for larger A-pattern deviations, but they can result in undesirable changes in torsion[4,5,6]
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