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Hachemi NEZZAR, Helene DALENS, Florian FARGUETTE, Frederic CHIAMBARETTA, Joyce MBEKEANI; Regression of inferior oblique recession for unilateral congenital and acquired superior oblique palsy: 10 year review. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5216.
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The superior oblique (SO) palsy is the most common isolated paralytic strabismus and the inferior oblique recession is one of the surgical techniques employed for managing this palsy.The aim of our study was to evaluate the long term efficacy of inferior oblique recession for the management of vertical deviation in congenital and acquired SO palsy
This study is a retrospective chart review of 62 patients with congenital and acquired superior oblique palsy managed with inferior oblique recession. All patients were operated at the University Hospital of Clermont-Ferrand between 1999 and 2010. Demographic analysis was conducted on all 62 patients. Forty-four patients submitted to final full ophthalmic and orthoptic assessment for this study and were analyzed for post-operative results. All measurements were performed using Maddox rod tests. Vertical, horizontal and cyclotortion measurements were taken pre and post-operatively, but only vertical deviations were evaluated for this study. Several criteria were considered: the first criterion was the initial angle of vertical deviation in primary gaze and the second was the angle of deviation in three postoperative periods: period (1) up to 2 years, period (2) between 2 and 5 years and period (3) more than 5 years. Quantitative data were analyzed using Student T and Mann-Whitney U tests and multiple groups were compared using ANOVA and Tukey Kramer tests
Women accounted for 41.9% of patients and men, 58.1%. The mean age of all patients when operated was 29.57years. Congenital SO palsy cases were 83.9% while 16.1% were acquired. The initial mean deviation in primary gaze position was 14.55 (± 8.2) dioptres. The average post-operative decrease in vertical deviations was by 11.6 dioptres for distance and by 9.95 dioptres for near. Surgical efficacy for vertical deviation correction at distance was 90.2% at 2 years, 76.9% between 2 to 5 years and 62% after 5 years. No significant difference in deviations was found when the initial deviations were greater than 25 dioptres
Our study confirms the efficacy of inferior oblique recession for management of congenital and acquired superior oblique palsy and documents regression of results over time. To our knowledge this is the first study to show this decline in efficacy after 5 years of follow up
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