Surgical management of superior oblique palsy with coexisting exotropia.
J AAPOS
; 27(5): 283.e1-283.e4, 2023 10.
Article
in En
| MEDLINE
| ID: mdl-37716432
ABSTRACT
PURPOSE:
To analyze the surgical results of patients treated for superior oblique palsy with coexisting exotropia.METHODS:
The medical records of patients with superior oblique palsy and exotropia who underwent inferior oblique weakening and simultaneous lateral rectus recession by a single surgeon from 1996 to 2022 were reviewed retrospectively. Demographics, pre- and postoperative vertical and horizontal deviation, and presence of diplopia were recorded. Surgical success was defined as horizontal deviation <10Δ and vertical deviation ≤4Δ without overcorrection or diplopia. The decision to operate for the horizontal deviation was made based on fusion in free space when the vertical deviation was offset with a prism.RESULTS:
A total of 27 patients were included. Mean age was 26.1 ± 22 years (range, 26 months to 78 years). Preoperatively, mean vertical deviation was 15.2Δ ± 7.5Δ (range, 4Δ-30Δ); mean exodeviation, 17Δ ± 5.5Δ (range, 10Δ-35Δ). Of the 27 patients, 25 underwent unilateral and 2 underwent bilateral lateral rectus recession, according to the magnitude of the horizontal deviation. Mean follow-up was 3 ± 3.8 months (range, 2 weeks to 17 months). Postoperative mean vertical alignment was 3.0 ± 5.9, and horizontal alignment was 3.4Δ ± 5.2Δ (esotropia of 7Δ to exotropia of 12Δ; P < 0.0001). Nineteen patients (70%) had a successful result; 2 patients had residual exotropia of >10Δ, 2 had vertical overcorrection (range, 3Δ-4Δ), and 6 had residual vertical deviation ≥4Δ (range, 5Δ-20Δ). None had secondary esotropia >10Δ. Horizontal deviation was corrected successfully with no consecutive esotropia in 25 patients.CONCLUSIONS:
In our study cohort, patients with superior oblique palsy and exotropia in whom fusion required both horizontal and vertical prism correction had a high likelihood of successful horizontal alignment after lateral rectus weakening in combination with inferior oblique surgery.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Esotropia
/
Exotropia
/
Trochlear Nerve Diseases
Limits:
Adolescent
/
Adult
/
Child
/
Child, preschool
/
Humans
/
Middle aged
Language:
En
Journal:
J AAPOS
Journal subject:
OFTALMOLOGIA
/
PEDIATRIA
Year:
2023
Type:
Article