The clinical features and surgical treatment of pediatric bilateral asymmetric superior oblique palsy patients

Abstract

Objective To summarize the clinical features and classification, and establish the corresponding surgical methods. Methods A noncomparative interventional case series collected 41 cases. Children patients with diagnosis of bilateral asymmetric superior oblique palsy were included in this study, and received surgical treatment from January 2010 to January 2016 in Guangzhou women and children's Medical Center. Follow-up was in 2 weeks, 1 month, and half a year. Postoperative loss contact cases were excluded. This topic summarized characteristics through clinical manifestations. Varied surgical methods for types of patients were used, postoperative results were analyzed, and the applicability of various methods of surgery was assessed. Results According to the clinical features the patients were divided into four types, and with varied surgical methods. Type I: preoperative obvious vertical eye position, compensatory head position and V sign in 1 case, did partial excision of the inferior oblique muscle in the eye with hyperthyroidism. It attained normal ocular alignment in primary position. Type II: preoperative obvious vertical eye position and V sign, no compensatory head posture of 20 patients with hyperthyroidism eyes did a partial excision of the inferi-or oblique muscle surgery. All attained normal ocular alignment in primary position. Type III: preoperative vertical eye position and compensatory head position was not obvious, but with V sign was 12 cases, inferior oblique part underwent binocular symmetric resection. All attained normal ocu-lar alignment in primary position, and had no compensatory head posture, only 1 case had a level undercorrection. Type IV: preoperative vertical eye position, compensatory head position, and V sign was not obvious in 8 cases, only horizontal direction strabismus surgery. All attained normal oc-ular alignment in primary position, and there was no compensatory head position. Conclusions Pediatric with non-symmetry superior oblique paralysis can be divided into several types according to their clinical features. By using different operation methods, operation can obtain satisfactory results. Key words: Incomitant strabismus; Non symmetry; Superior oblique palsy; Ocular surgery