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H. Steffen, G.H. Kolling; Effectiveness of oblique muscle surgery in acquired and congenital oblique superior palsy . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5018.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To investigate the effectiveness of oblique muscle surgery in patients with acquired and congenital superior oblique palsy (SOP) Methods: The charts of all patients with unilateral superior oblique palsy, who were operated on by the authors between 1993 and 2003 were analysed. Patients could be divided into three groups: Patients with an acquired SOP (n=25), who were operated by a tuck of the entire superior oblique (SO) tendon between 3 and 8 mm were attributed to group I . Group II and III contained patients with congenital SOP who were operated on either by a recession of the inferior oblique (IO) muscle using Fink's technique (groupII, n=32) or a combined procedure with recession of the IO and tuck of the SO tendon of the involved eye(groupIII, n=87). Results: In group I tucking of the entire tendon of the SOP by 6, 8 or 10 mm reduces the vertical deviation (VD) in adduction by about 0.7 to1° per mm. Reduction of the excyclotropia was less predictive and ranged between 0.5 to 1.8° per mm (mean 1°). In group II, recession of the IO by 6, 8 or 10 mm recuced the VD in adduction between 4° and 7° corresponding to an effectiveness of 0.7–1° per mm.The reduction of the eycyclotropia ranged from 0.7 to 1.4° per mm. In group III, the combined oblique muscle surgery, which was chosen, when the VD in adduction was above 10° resulted in a reduction of the VD in adduction by 1.4° per mm. The excxclotropia was reduced by 1° per mm (as in group I and II). In addition there was a reduction of a V–Symptom by about 5° in all groups which was not dose dependent. Conclusions: Most patients with a SOP can effectively be treated by oblique muscle surgery alone. In patients with a VD of 10° in adduction and more, combined oblique muscle surgery is an effective approach to reduce both, the VD and the cyclotropia. There is a dose dependent almost linear relationship between the amount of operation and the reduction of the VD especially in the combined oblique muscle surgery procedure. Reduction of the cyclotropia is less dose dependent as is the reduction of the V–Symptom.
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