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.

5 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Strabismus surgery may restore limited binocular function and improve cosmesis in patients with paralytic strabismus. Evaluation of the amount of residual function of the affected extraocular muscles is essential to determine which surgical procedure will yield the best results. Standard muscle resection techniques are effective for patients who have paretic extraocular muscles with residual function. Muscle transposition procedures are indicated for patients with total paralysis of an extraocular muscle. Autogenous and alloplastic materials may be required to fix the eye in primary position in patients with total paralysis of multiple extraocular muscles. This article discusses the recent literature regarding the evaluation and management of patients with paralytic strabismus. Current concepts regarding extraocular muscle transposition and the use of autogenous materials are emphasized.
    Current Opinion in Ophthalmology 01/2002; 12(6):408-18. DOI:10.1097/00055735-200112000-00005 · 2.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To review and update the management of superior oblique extraocular muscle clinical paresis and palsy, (SOP) employing and applying recent advances in the diagnosis and surgical methods. These include three recently introduced forced duction tests, respectively for laxity of the SO tendon, absence of the SO tendon, and contracture of the ipsilateral superior rectus muscle. Also discussed are the pathophysiologic mechanisms behind various modes of clinical presentation of SOP, older concepts requiring scrutiny, and prior surgical methods which should no longer be employed due to advances in our knowledge. These newer aspects of SOP management are organized and displayed in a revised Plager flow sheet to facilitate their application.
    Binocular vision & strabismus quarterly 02/2003; 18(1):15-24.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Unilateral long-standing superior oblique palsy may lead to superior rectus overaction/contracture requiring surgery of multiple extraocular muscles to correct the hypertropia. We review our technique of tucking the superior oblique combined with immediate postoperative adjustable suture recession of the ipsilateral superior rectus. Twelve patients during the course of 2.5 years with longstanding vertical diplopia unrelated to closed head trauma or systemic disease who underwent our surgical technique were identified. The hypertropia in all patients was largest across the lower field (Knapp class 5) or nasal and lower fields (Knapp class 4). Outcome measures were primary-position hypertropia and vertical diplopia. The mean preoperative hypertropia in primary gaze measured 17.8 PD (range, 4 to 30). The mean 2-week postoperative vertical deviation was 1.3 PD (range, 4 PD hypotropic to 6 PD hypertrophic). The mean 6-week postoperative vertical deviation was 1.9 PD (range, 2 PD hypotropic to 12 PD hypertrophic). Diplopia in primary and down gaze, which was universally present before surgery, resolved in 11 of the 12 patients (92%). This combination of procedures appears to be a highly successful choice for treatment of unilateral long-standing superior oblique palsy. Advantages for both patient and surgeon include adequate exposure through a single conjunctival incision, elimination of risks to the contralateral eye, and immediate intraoperative suture adjustment of the ipsilateral superior rectus.
    Journal of American Association for Pediatric Ophthalmology and Strabismus 07/2003; 7(3):195-9. DOI:10.1016/mpa.2003.S1091853103000132 · 1.00 Impact Factor
Show more