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R. Sachdeva, A. Marcotty, P. J. Rychwalski, E. I. Traboulsi; Comparison of Inferior Oblique Myectomy to Recession for the Treatment of Superior Oblique Palsy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3008.
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Clinical complications of superior oblique (SO) palsy can be treated by myectomy or recession of the ipsilateral inferior oblique (IO). There is limited data available on the comparison of these two surgical modalities. We compare IO myectomy to recession for the treatment of SO palsy.
A retrospective chart review identified all patients with SO palsy who underwent IO weakening procedures. Diagnosis of SO palsy was based on a positive Parks three-step test. Patients were excluded if IO muscle surgery was combined with other vertical muscle surgery and if there was a follow up of less than 4 weeks. Deviation measurement in all positions of gaze and head tilt, the presence or absence of IO overaction, diplopia, and compensatory head tilt preoperatively and at last follow up visit were recorded. We divided patients into: (1) those with large vertical deviation (greater than or equal to 20 prism diopters (PD) hypertropia (HT)); and (2) those with small-moderate deviation (less than 20 PD HT). Outcome parameters were: improvement of deviation in primary gaze (defined as less than or equal to 4 PD residual HT at last follow up), resolution of diplopia in primary and reading gazes, and correction of head tilt position. Comparisons were made using chi-square 2-sample analysis.
There were 85 eyes of 79 patients. 40 eyes underwent myectomy, and 45 underwent recession. Mean age was 22.9 years (range:1-64 yrs). 23 eyes (27%) had large HT, and 62 (73%) had small-moderate HT. Follow up ranged between 4 weeks and 9 years. Results are in Table 1. Patients who underwent myectomy in both groups had improvement in nearly all parameters. There was a statistically significant superior efficacy of myectomy over recession in the reduction of HT (p=0.03) and correction of head tilt (p=0.05) in the small-moderate group.
IO weakening is effective in the treatment of SO palsy. Our findings support myectomy as being more effective than recession in improving HT in primary gaze and correcting head tilt in patients with small-moderate HT. A larger randomized prospective trial is better suited to validate these findings.
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