Outcome of surgery for superior oblique palsy with contracture of ipsilateral superior rectus treated by superior rectus recession.
ABSTRACT To report our experience with this special subgroup of patients with superior oblique palsy.
All six patients seen since 1990 which the senior author treated who had a unilateral superior oblique palsy accompanied by ipsilateral superior rectus muscle contracture. Surgical management included superior rectus recession along with treatment of the superior oblique palsy by one of several appropriate procedures.
Five out of six had an "excellent" surgical outcome defined as no diplopia in primary and reading position, elimination of their abnormal head posture and normalization of versions postoperatively. The sixth patient continued to have a small intermittent vertical deviation, but was functionally satisfactory.
This subset of individuals with superior oblique palsy and ipsilateral rectus contracture can be improved with weakening of the ipsilateral superior rectus as part of the surgical plan.
Chapter: Ocular Motility Disorders09/2006: pages 423-519;
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ABSTRACT: • Careful preoperative assessment and a correct diagnosis of the problem are the essential factors for a successful outcome of surgical treatment. • The pearl to go through the correct route in surgical management of paralytic strabismus is to know the questions that need to be answered during the preoperative assessment. The correct answers for these questions clarify the method of appropriate surgical treatment. • During the preoperative assessment, the potential for fusion must be carefully evaluated. Acquired loss of fusion or, in other words, central fusion disruption may coexist in acquired paralytic ocular motility problems. In such cases, restoration of the ocular alignment may make the symptoms worse because of the increased awareness of diplopia with two overlapping images. • The aims of surgical treatment are primarily to obtain a diplopia-free field, to achieve symmetric ocular motility and a good looking eye that will allow eye contact, and to correct the abnormal head posture, if any. • The major pitfall in paralytic strabismus is the coexistence of a restrictive element. The secondary restrictions may mask the partial functional recovery in a paretic extraocular muscle (EOM), and sometimes they may become a more prominent problem than the paralytic condition itself. • The restoration of ocular alignment should be planned to create a new balance in both eyes. Paralytic strabismus is a binocular problem even in cases with unilateral involvement. There should be no hesitation to operate the sound eye where necessary. • The methods of surgical treatment primarily aim to weaken the unopposed overaction of the antagonist, then to strengthen the paretic muscle where possible or to create a mechanical effect by transposition, and finally to weaken the yoke muscle in the sound eye. In certain cases like complete third nerve palsy, creating a restriction with surgery may be required to keep the eye in primary position.
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ABSTRACT: In unilateral congenital superior oblique palsy, a large hypertropia is sometimes associated with ipsilateral contracture of the superior rectus muscle and apparent overaction of the contralateral superior oblique. Ipsilateral double elevator weakening is one surgical approach; however, this procedure could compromise supraduction. We report a series of three consecutive patients who underwent ipsilateral superior rectus and inferior oblique recessions for unilateral superior oblique palsy. Intraoperatively, all three patients were found to have a lax ipsilateral superior oblique tendon. Postoperatively, all three patients had satisfactory correction of the hypertropia and abnormal head position with minimal supraduction defect. This procedure seems to be an acceptable initial surgical option for treating congenital superior oblique muscle palsy with ipsilateral contracture of the superior rectus muscle, even when the ipsilateral superior oblique tendon is lax.Journal of AAPOS: the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus 06/2012; 16(3):301-3. DOI:10.1016/j.jaapos.2012.02.013 · 1.14 Impact Factor