Abstract
Purpose:
To determine the frequency and distribution of horizontal misalignment in patients with unilateral superior oblique palsy (SOP) and to determine the indications for combining horizontal with vertical strabismus surgery.
Methods:
Patients included in the study had a vertical heterophoria or tropia that fit Parks three-step test for SOP and had no previous strabismus surgery or other ocular motility disturbance. Ocular motility and alignment were recorded. Outcomes between patients who had vertical surgery alone and those who had combined vertical and horizontal surgery were compared using the Student’s t test.
Results:
Of 205 patients, 121 (59.0%) had a horizontal misalignment in addition to vertical strabismus. Ninety-six patients (46.8%) required strabismus surgery. Of these, 29 had 8 prism diopters (PD) or more horizontal deviation. Twenty-two had vertical combined with horizontal surgery (V+H group). Although their initial deviation was greater, these patients had better surgical outcomes than patients who had vertical surgery alone (V group). The V+H group had a final mean horizontal deviation of 2.18 PD compared with 6.85 PD in the V group (P < .01). Postoperative vertical alignment in the V+H group was also superior with a final mean vertical deviation of 3.7 versus 6.8 PD for the V group (P = .12).
Conclusion:
These results indicate that horizontal misalignment is common in patients with SOP. Patients with 8 PD or more horizontal deviation benefited from surgical correction of the horizontal deviation in addition to the vertical surgery.
- 1.Simonsz HJ, Crone RA, van der Meer J, Merckel-Timmer CF, van Mourik-Noordenbos AM. Bielschowsky head-tilt test: I. Ocular counterrolling and Bielschowsky head-tilt test in 23 cases of superior oblique palsy. Vision Res. 1985; 25:1977–1982
10.1016/0042-6989(85)90022-7 Crossref Medline, Google Scholar - 2.von Noorden GK, Murray E, Wong SY. Superior oblique paralysis: a review of 270 cases. Arch Ophthalmol. 1986; 104:1771–1776. Crossref Medline, Google Scholar
- 3.Parks MM. Isolated cyclovertical muscle palsy. AMA Arch Ophthalmol. 1958; 60:1027–1035. Crossref Medline, Google Scholar
- 4.Hatz KB, Brodsky MC, Killer HE. When is isolated inferior oblique muscle surgery an appropriate treatment for superior oblique palsy?Eur J Ophthalmol. 2006; 16:10–16. Crossref Medline, Google Scholar
- 5.Nucci P. Superior oblique palsy: promoting a simpler approach. Eur J Ophthalmol. 2006; 16:1–2. Crossref, Google Scholar
- 6.Duranoglu Y. Effectiveness of disinsertion-resection and tucking of the inferior oblique muscle in patients with unilateral long-standing superior oblique muscle palsy. J Pediatr Ophthalmol Strabismus. 2007; 44:283–287. Link, Google Scholar
- 7.Tollefson MM, Mohney BG, Diehl NN, Burke JP. Incidence and types of childhood hypertropia: a population-based study. Ophthalmology. 2006; 113:1142–1145.
10.1016/j.ophtha.2006.01.038 Crossref Medline, Google Scholar - 8.Mansour AM, Reinecke RD. Central trochlear palsy. Surv Ophthalmol. 1986; 30:279–297.
10.1016/0039-6257(86)90061-5 Crossref Medline, Google Scholar - 9.Harris DJ, Memmen JE, Katz NN, Parks MM. Familial congenital superior oblique palsy. Ophthalmology. 1986; 93:88–90. Crossref Medline, Google Scholar
- 10.Astle WF, Rosenbaum AL. Familial congenital fourth cranial nerve palsy. Arch Ophthalmol. 1985; 103:532–535. Crossref Medline, Google Scholar
