J Korean Ophthalmol Soc.  2009 Feb;50(2):253-259. 10.3341/jkos.2009.50.2.253.

The Effect of Minimal Amount Inferior Oblique Recession in Superior Oblique Palsy

• Lee KH
• Kyung SE
• Chang MH

• KMID: 2212059
• DOI: http://doi.org/10.3341/jkos.2009.50.2.253

Abstract

PURPOSE: To investigate the effect of vertical deviation change, head tilt and diplopia relief, we performed a minimal amount of inferior oblique recession regardless of the vertical deviation angle and the degree of inferior oblique overaction (IOOA) in superior oblique palsy patients.
METHODS
We retrospectively analyzed 20 cases of unilateral congenital or acquired superior oblique palsy, which were treated with inferior oblique muscle recession from May 2005, to August 2007. We compared vertical deviation change, head tilt and diplopia relief following surgery. Improvement of head tilt was determined by patient satisfaction measurements. The inferior oblique muscle was attached 4 mm posterior and 2 mm temporal to the lateral border of the inferior rectus muscle insertion in all patients.
RESULTS
The average angle of vertical deviation prior to surgery was 12.4 prism diopters (PD), and the total average correction in the angle of vertical deviation after surgery was 9.6PD. After surgery, head tilt improved in 13 of 16 eyes(81%), and of the four remaining eyes, vertical diplopia was absent.
CONCLUSIONS
Although vertical deviation remained after surgery, if patients have enough vertical fusional amplitude, they should be able to overcome the diplopia and the head tilt. Judging from the indication of inferior oblique recession in diplopia and cosmetic problem in superior oblique palsy, a minimal amount of inferior oblique recession is thought to be an effective treatment of unilateral superioroblique palsy with no significant IOOA.

Keyword

Diplopia; Head tilit; Inferior oblique overaction; Inferior oblique recession; Superior oblique palsy

MeSH Terms

Cosmetics
Diplopia
Eye
Head
Humans
Muscles
Paralysis
Patient Satisfaction
Retrospective Studies
Cosmetics

Reference

References

1. von Noorden GK, Murray E, Wong SY. Superior oblique paralysis. A review of 270 cases. Arch Ophthalmol. 1986; 104:1771–6.

2. Metz HS. Think superior oblique palsy. J Pediatr Ophthalmol Strabismus. 1986; 23:166–9.

3. Reynolds JD, Biglan AW, Hiles DA. Congenital Superior oblique palsy in infants. Arch Ophthalmol. 1984; 102:1503–5.

4. Sydnor CF, Seaber JH, Buckley EG. Traumatic superior oblique palsies. Ophthalmology. 1982; 89:134–8.

5. Kushner BJ. The diagnosis and treatment of bilateral masked superior oblique palsy. Am J Ophthalmol. 1988; 105:186–94.

6. Spierer A, Schwalb E. Superior oblique muscle paresis after sub-Tenon's anesthesia for cataract surgery. J Cataract Refract Surg. 1999; 25:144–5.

7. Sloper J. Clinical strabismus management: Principles and Surgical Techniques. Br J Ophthalmol. 2000; 84:1333.

8. Heo H, Park SW, Park YG. The effect of inferior oblique muscle surgery in congenital superior oblique palsy. J Korean Ophthalmol Soc. 2007; 48:541–6.

9. Knapp P. First Annual Richard G. Scobee Memorial Lecture. Diagnosis and surgical treatment of hypertropia. Am Orthopt J. 1971; 21:29–37.

10. Del Monte MA, Parks MM. Denervation and extripation of the inferior oblique. An improved weakening procedure for marked overaction. Ophthalmology. 1983; 90:1178–85.

11. Duane A. Tenotomy of inferior oblique and consideration of the conditions that may call for the operation. Br Med J. 1906; 2:1867–70.

12. White JW. Surgery of the inferior oblique at or near the insertion. Am J Ophthalmol. 1942; 40:118–26.

13. Parks MM. A study of weakening surgical procedures for eliminating overaction of the inferior oblique. Trans Am Ophthalmol Soc. 1971; 69:163–87.

14. Parks MM. The weakening surgical procedures for eliminating overaction of the inferior oblique muscle. Am J Ophthalmol. 1972; 73:107–22.

15. Wright KW. Pediatric ophthalmology and strabismus. St. Louis: CV Mosby;1995. p. 287–91.

16. Muchnick RS, McCullough DH, Strominger MB. Comparison of anterior transposition and recession of the inferior muscle in unilateral superior oblique paresis. J AAPOS. 1998; 2:340–3.

17. De Angelis D, Makar I, Kraft SP. Anatomic Variations of the Inferior Oblique Muscle: A potential cause of failed inferior oblique weakening surgery. Am J Ophthalmol. 1999; 128:485–8.

18. Simons BD, Saunders TG, Siatkowski RM, et al. Outcome of surgical management of superior oblique palsy: a study of 123 cases. Binocul Vis Strabismus Q. 1998; 13:273–82.

19. 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; 44:283–7.

20. Chang YH, Ma KT, Lee JB, Han SH. Anterior transposition of inferior oblique muscle for treatment of unilateral superior oblique muscle palsy with inferior oblique muscle overaction. Yonsei Med J. 2004; 45:609–14.