Outcome of surgery for superior oblique palsy with contracture of ipsilateral superior rectus treated by superior rectus recession.

Bascom Palmer Eye Institute, Ann Bates Leach Eye Hospital, Miami, Florida, USA.
Binocular vision & strabismus quarterly 02/1998; 13(3):177-80.
Source: PubMed


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.

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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.
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