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Binocul Vis Strabismus Q. 1998;13(4):273-82.

Outcome of surgical management of superior oblique palsy: a study of 123 cases.

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1
Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.

Abstract

PURPOSE:

To determine the outcome of the surgical management of superior oblique palsy at our institution.

SUBJECTS AND METHODS:

Retrospective review of 123 patients who underwent surgical correction of superior oblique paresis at Bascom Palmer Eye Institute from 1976 to 1996. Subject-Patients: 67% were male and 33% female. The mean age at surgery was 30.5 years (range, 2-78 years). Etiologies of the pareses were trauma (34%), congenital (33%), and acquired/non-traumatic (33%). The mean angle of preoperative vertical deviation in primary gaze was 14.0 delta (range, 0-45 delta).

SURGERY:

109/123 (89%) patients underwent single muscle surgery. Of these 109, 57 had single oblique muscle surgery: a superior oblique tuck in 34/57 (60%); an inferior oblique weakening procedure in 22/57 (38%); and a Harada-Ito procedure in 1/57 (2%). The other 14 patients (11%) had bilateral surgery.

RESULTS:

The final postoperative vertical deviation in primary gaze was < or =3 PD in 60% of patients and < or =7 PD in 80%. The mean change in primary position vertical deviation postoperatively was 10.4 PD for distance and 13.0 PD for near. An "excellent" outcome (final vertical deviation &le3 PD in primary and reading gazes) was achieved most frequently in those patients with congenital pareses and isolated oblique muscle surgery.

COMPLICATIONS:

Clinically significant Brown's Syndrome occurred in 43/72 (60%) of those cases who had undergone a superior oblique tuck. The incidence of Brown's Syndrome was unrelated to tuck size. Reoperation was three times more likely to be necessary in traumatic cases than in congenital cases (35.0% vs 11.9%, p=0.02).

CONCLUSIONS:

Based on these results we recommend oblique muscle surgery as the initial procedure to correct superior oblique palsy when appropriate.

PMID:
9852442
[Indexed for MEDLINE]

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