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T. T. Pham, G. R. Kosmorsky; Long-Term Outcome Following Surgical Treatment of Superior Oblique Myokymia Using a Reverse Harada-Ito Procedure. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2575.
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Superior oblique myokymia (SOM) is an eye movement disorder in which patients experience oscillopsia and/or vertical or torsional diplopia. The chronic condition often responds poorly to medical therapy. We investigated clinical features and long-term outcome of patients with SOM who underwent a reverse Harada-Ito (recession or resection of the anterior aspect of the superior oblique tendon) procedure.
After obtaining IRB approval, we evaluated the medical records of all 16 patients with the diagnosis of SOM who underwent the reverse Harada-Ito procedure between 1992 and 2007 at the Cole Eye Institute in Cleveland, Ohio. At time of follow-up, we contacted patients regarding symptom frequency and change compared to pre-surgery symptoms.
Sixteen patients underwent surgical treatment for their SOM utilizing the reverse Harada-Ito procedure between 1992 and 2007. There were 3 males (19%) and 13 females (81%). The mean age of onset was 40 years (range, 19 - 56 years of age). Average time between presentation and surgical treatment was 13 months (range, 1 day - 10.4 years). The right eye (63%) was more frequently affected than the left eye (37%). There were no bilateral cases. Oscillopsia presented in 7 patients (44%), diplopia in 5 patients (31%), and both in 4 patients (25%). 11/16 patients (69%) had received prior medical therapy (the others had declined medical therapy). Of the 11 patients on medical treatments for the SOM, 6 (55%) had been on multiple medications prior to surgery. Follow-up for 11 patients (69%) was obtained. Average post-operative follow-up was 6.4 years (range, 1 month - 11 years). Postoperative symptomatic improvement was none in 2/11 patients (18%), 90% in 2/11 patients (18%), and 100 % in 4/11 patients (36%). Three patients reported improvement in symptoms of 50%, 75% and <10%, respectively. Overall, 8/11 patients (73%) reported ≥ 50% improvement in symptoms at time of follow-up. No patients reported worsening of symptoms following surgery. Anatomic abnormalities of the superior oblique muscle were noted in 5/16 patients at surgery. Follow-up for 3/5 of these patients was obtained, and showed improved symptoms of 0%, 50%, and 75%, respectively.
The reverse Harada-Ito procedure appears to be a viable treatment for the treatment of SOM. 73% of patients reported ≥ 50% improvement in symptoms. Anatomic abnormalities involving the superior oblique muscle may be associated with SOM.
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