Abstract
Purpose
To evaluate the usefulness of inferior oblique (IO) weakening surgery on a paretic eye for correcting vertical deviation in three positions of gaze by comparing the surgical results in 2 types of unilateral superior oblique (SO) palsy.
Methods
The patients were divided into 2 groups: 27 patients fixated with the paretic eye and 61 patients fixated with the non-paretic eye (control). The former had hypotropia and the latter hypertropia. All patients underwent IO recession of the paretic eye. We compared the corrective effects, percentage changes in the decrease of vertical deviation of the primary position (PP), vertical deviation on ipsilateral head tilt, i.e., the Bielschowsky head-tilt phenomenon (BHP), and differences in vertical deviation between ipsilateral and contralateral head tilt (BHTD) relative to the preoperative values between the 2 groups.
Results
Mean percentage decrease in vertical deviation of the BHP and BHTD in the control group was larger at 3, 6, and 12 months, but no significant difference was observed between the 2 groups except for the BHP at 12 months (52% for case vs. 70% for control, p = 0.04).
Conclusions
IO weakening in the paretic eye was effective irrespective of the preferred eye for fixation on PP and head-tilt position.
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References
Knapp P. Diagnosis and surgical treatment of hypertropia. Am Orthop J. 1971;21:29–37.
Knapp P. Paretic squints. Symposium on strabismus. Trans New Orleans Acad Ophthalmol. 1978;24:350–7.
Kushner BJ. Ocular torsion: rotations around the “WHY” axis. J AAPOS. 2004;8:1–12.
Mori R. Studies on the binocular counter-rolling induced by head tilt in man. Part 1. On the coordination of the counter-rolling of both eyes in normal cases. Nippon Ganka Gakkai Zasshi. 1973;77:753–60.
Collewijn H, Van der Steen J, Ferman L, Jansen TC. Human ocular counterroll: assessment of static and dynamic properties from electromagnetic scleral coil recordings. Exp Brain Res. 1985;59:185–96.
Simonsz HJ, Crone RA, van der Meer J, Merckel-Timmer CF, van Hourik-Noordenbos AM. The Bielschowsky head-tilt test. I. Ocular counterrolling and Bielschowsky head-tilt test in 23 cases of superior oblique palsy. Vision Res. 1985;25:1977–82.
Fujiwara Y. The study of ocular counterrolling using CCD cameras with video-based technique. 1. On normal subject. Nippon Ganka Gakkai Zasshi. 1988;92:565–72.
Schworm HD, Yagge J, Pansell T, Lennerstrand G. Assessment of ocular counterroll during head tilt using binocular video oculography. Invest Ophthalmol Vis Sci. 2002;43:662–7.
Hamasaki I, Hasebe S, Ohtsuki H. Static ocular counterroll: video-based analysis after minimizing the false-torsion factors. Jpn J Ophthalmol. 2005;49:497–504.
Esmail F, Flanders M. Masked bilateral superior oblique palsy. Can J Ophthalmol. 2003;38:476–81.
Kushner BJ. Errors in the three-step test in the diagnosis of vertical strabismus. Ophthalmology. 1989;96:127–32.
Russmann W. Messung der Kopfzwangshaltung. In: Kaufmann H, editor, Strabismus. Stuttgart: Enke; 1994. p. 457–9.
Ohtsuki H. Cyclovertical strabismus. In: Uemura Y, editor. Practice of orthoptics. Tokyo: Igaku Shoin; 1992. p. 95–128.
Wright KW. Inferior oblique muscle surgery. In: Wright KW, editor. Color atlas of ophthalmic surgery strabismus. Philadelphia: Lippincott; 1991. p. 173–200.
Dickey CF, Scott WE, Cline AR. Oblique muscle palsies fixating with the paretic eye. Surv Ophthalmol. 1988;33:97–107.
Olivier P, von Noorden Gk. Excyclotropia of the nonpareitc eye in unilateral superior oblique muscle paralysis. Am J Ophthalmol. 1981;93:30–3.
Mahmoud TA, Flanders M. Treatment of Knapp class V superior oblique palsy with contralateral inferior rectus muscle recession. Can J Ophthalmol. 2009;44:320–2.
Prieto-Diaz J, Gamio MS. The surgical innervational effect: utilizing it to treat monocular elevation deficiency strabismus. Binocul Vis Strabismus Q. 2007;22:169–78.
Schulz E, Haase W. Okulomotorische Fehlregenerationen: operative Massnahmen. Z prakt Augenheilkd. 1985;6:261–4.
Ohtsuki H, Konishi Y, Hasebe S, Tadokoro Y. Surgery for oculomotor nerve palsy with misdirection syndrome. Rinsho Gannka. 1990;44:1889–93.
Gonzalez C, Chen HH, Ahmadi MA. Sherrington innervational surgery in the treatment of chronic six nerve paresis. Binocul Vis Strabismus Q. 2005;20:159–66.
Kaufmann H. Paretischen scielen. In: Kaufmann H, editor. Strabismus. Stuttgart: Enke; 1986. p. 466–9.
Morad Y, Weinstock VM, Kraft SP. Outcome of inferior oblique recession with or without vertical rectus recession for unilateral superior oblique paresis. Binocul Vis Strabismus Q. 2001;16:23–8.
Hayat A, Tardieu C, Tabary JC, Tabary C. Effects of denervation on the reduction of sarcomere number in cat soleus muscle immobilized in shortened position during seven days. J Physiol. 1978;74:563–7.
Goldspink G, Tabary C, Tabary JC, Tardien C, Tarden G. Effect of denervation on the adaptation of sarcomere number and muscle extensibility to the functional length of the muscle. J Physiol. 1974;236:733–42.
Simonsz HJ. The mechanics of squint surgery. In: Weiss J-B, editor. Acta Strabologica. Paris: CERES; 1990. p. 17–9.
Mataftsi A, Strickler J, Klainguti G. Vertical and torsional correction in congenital superior oblique palsy by inferior oblique recession. Eur J Ophthalmol. 2006;16:3–9.
Metten M, Link H, Staubach F, Bach M, Lgreze WA. Dose–response relationship in inferior oblique muscle recession. Graefe’s Arch Clin Exp Ophthalmol. 2008;246:593–8.
Crone RA. Ocular torticollis in cases of eye muscle palsy. In: Diplopia. Amsterdam: Excerpta Medica; 1973. pp. 210–1.
Ichikawa R. Surgical treatment of superior oblique palsy. Part 1. Long term surgical effects with reference to ocular dominance and Bielschowsky head-tilt test. Rinsho Gannka. 1981;35:611–20.
Ichikawa R. Surgical treatment of superior oblique palsy. Part 2. Long term effect of superior rectus recession of the paretic eye. Rinsho Gannka. 1982;36:925–32.
Kushner BJ. The influence of head tilt on ocular torsion in patients with superior oblique palsy. J AAPOS. 2009;13:132–5.
Acknowledgments
This study was supported in part by a Grant-in-Aid for Scientific Research in Japan (no. 22591964) and the Koyama Fund.
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Kishimoto, F., Hasebe, S. & Ohtsuki, H. Effects of inferior oblique muscle-weakening surgery on the Bielschowsky head-tilt phenomenon in patients with superior oblique palsy habitually fixating with the paretic eye. Jpn J Ophthalmol 55, 525–533 (2011). https://doi.org/10.1007/s10384-011-0055-x
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DOI: https://doi.org/10.1007/s10384-011-0055-x