Abstract
BackgroundTo evaluate the effect of modified superior oblique intrasheath tenectomy (MSOIT) on superior oblique overaction (SOOA) with A-pattern.MethodsWe retrospectively reviewed the data of 66 patients (130 eyes) with SOOA and A-pattern underwent MSOIT at the nasal border of the superior rectus under an operating microscope between January 1, 2004 and December 31, 2018. The superior oblique (SO) tendon fibres were resected, and the sheath was preserved in all patients. The preoperative and postoperative SOOA, objective torsion, ocular motility, and A-pattern deviation findings were compared. The correlation between the preoperative A-pattern deviation and the corrected deviation was analysed. The average follow-up period was 33.45 ± 29.88 (range: 12–122) months.ResultsThe mean SOOA deviation improved from 2.95 ± 0.54 to 0.34 ± 0.55 (P < 0.001), while the A-pattern deviation difference between upgaze and downgaze improved from 23.15 ± 7.59 prism diopters (PD) to 3.50 ± 2.90 PD (P < 0.001). The average objective fundus intorsion value improved from + 2.96 ± 0.58 to + 0.38 ± 0.60 (P < 0.001). The magnitude of correction in A-pattern was significantly correlated with the preoperative severity of A-pattern (r = 0.812, P < 0.001).ConclusionsMSOIT at the nasal border of the superior rectus (SR) under an operating microscope is safe and yields beneficial outcomes in patients with SOOA and A-pattern.
Highlights
To evaluate the effect of modified superior oblique intrasheath tenectomy (MSOIT) on superior oblique overaction (SOOA) with A-pattern
Over the past 15 years, we have performed modified superior oblique intrasheath tenectomy (MSOIT) with a small incision under a surgical microscope and found that it is effective for treating Apattern with SOOA
One eye suffered from mild inferior oblique overaction without obvious superior oblique underaction in our early experience
Summary
To evaluate the effect of modified superior oblique intrasheath tenectomy (MSOIT) on superior oblique overaction (SOOA) with A-pattern. Superior oblique overaction (SOOA) corresponds to excessive activity of the superior oblique muscle in directions including intorsion, depression, and abduction [1]. Patients with SOOA may show abduction in downgaze, causing A-pattern [1]. The superior oblique (SO) weakening procedures include tenotomy, tenectomy, recession, split-tendon lengthening, and silicone tendon. Minimal anatomical disruption, swelling and pain and good visualization have been achieved in rectus muscle surgery and oblique muscle recession [9]. Over the past 15 years, we have performed modified superior oblique intrasheath tenectomy (MSOIT) with a small incision under a surgical microscope and found that it is effective for treating Apattern with SOOA
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