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M Acosta, GA Campomanes, D Romero-Apis, F Zavaleta; Dvd Combined With Superior Oblique Overaction ("a" Pattern): Four Oblique Muscles Surgery . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1478.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Purpose to weak both superior obliques to treat the superior oblique overaction (SOOA) and instead of making bilateral superior recti recession, doing bilateral inferior oblique anterior transposition. The SOOA and the DVD would be treated avoiding the consecutive presence of inferior oblique overaction. Methods: Patients from the Fundacion Hospital Ntra. Sra. De la Luz , IAP with DVD quantified from + to ++++ and SOOA quantified from + to +++ in the period from 1997 to 1999 were studied. Hypotropia in adduction, Bielschowsky head tilt test, measurement of A pattern in prism diopters, and pre-operative and post-operative photographic control were made. with 2 years follow-up. Inferior oblique is disinserted from the globe holding it with a Prince forceps, and reatached to the globe lateral to the inferor rectus at the level of its insertion, superior rectus is held with a hook and the superior oblique tendon is dissected and tenectomized between two Kelly clamps with a separation of 7 mm Simultaneous horizontal surgery deviation was done. Results: Sixty patients with DVD and SOOA were studied. In the pre-opertive 39 cases presented moderate DVD (++) and 21 cases had significant DVD (+++); 82 eyes presented moderate SOOA (++) and 38 eyes had significant SOOA (+++); hypotropia in adduction was present in 34 eyes: the degree of the A pattern was moderate in 28 patients (15 to 25 pd) and significant in 32 patients (30 to 40 pd); Bielschowsky head tilt test was negative in all cases: At the end of the post-operative follow-up in 56 patients DVD diminished to mild (+) and in 4 patients disappeared completely ; in 115 eyes SOOA disappeared completely and in 5 cases remained with a residual deviation (+); A pattern in those cases with 15 to 25 pd in all 28 cases disappeared completely, and in those patients with 30 to 40 pd in 20 of them also disappeared completely and in 4 cases remained a residual of 10 pd; Bielschowsky headt tilt test remained negative in all patients. The complications observed were: moderate limitation of elevation in abduction (++) in 30 eyes, subconjunctival nodule in the lateral-inferior quadrant in 13 eyes, and mild Brown´s syndrome in 5 eyes. Conclusion: DVD combined with SOOA can be efectivelly treated with this surgical procedure. Surgery on four obliques do not affect the horizontal allignement outcome, and does not create torsional changes. Complications are minimal.
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