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

Kwan Hoon Lee; Seong Eun Kyung; Moo Hwan Chang

doi:10.3341/jkos.2009.50.2.253

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Lee, Kyung, and Chang: The Effect of Minimal Amount Inferior Oblique Recession in Superior Oblique Palsy

Original Article

J Korean Ophthalmol Soc 2009;50(2):253-259.

Published online: 3 January 2009

DOI: https://doi.org/10.3341/jkos.2009.50.2.253

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

Kwan Hoon Lee, MD, Seong Eun Kyung, MD, Moo Hwan Chang, MD

Department of Ophthalmology, The Dankook University Medical College, Cheonan, Korea

Address reprint requests to Seong Eun Kyung, MD Department of Ophthalmology, Dankook University College of Medicine #San 16-5 Anmseo-dong, Cheonan, Chungnam 330-714, Korea Tel: 82-41-550-6377, Fax: 82-41-561-0137, E-mail: kseeye@hanmail.net

Received 24 April 2008 Accepted 11 September 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Diplopia, Head tilit, Inferior oblique overaction, Inferior oblique recession, Superior oblique palsy

References

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Table 1.

Clinical characteristics of the patients

	Sex/ Age	Cause of SO^††† palsy	IOOA^§§ degree	Preop deviation	OP amount	Postop deviation	Preop head tilt	Postop head tilt	Preop diplopia	Postop diplopia
No. 1	M/43	trauma	IOOA^§§ +1	12△ LHT^∏^†	L) IO^** recession	4△ XT^†	o	o	x	x
				6△ XT^†					x	x
No. 2	M/14	congenital/idiopathic	IOOA^§§ +2	15△ RHT^§	R) IO^** recession	ortho	o	x	o	x
				4△ XT^†					o	x
No. 3	M/14	congenital/idiopathic	IOOA^§§ +2	25△ XT^†	R) LR^* 8 mm	6△ XT^†
				6△ RHT^§	IO^** recession	1△ RHT^§	o	x	o	x
No. 4	M/21	trauma	IOOA^§§ +1	12△ RHT^§	R) IO^** recession	2△ RHT^§	o	x	o	x
No. 5^#	M/6	congenital/idiopathic	IOOA^§§ +2	6△ RHT^§	R) IO^** recession	ortho	o	x	x	x
No. 6	M/34	congenital/idiopathic	IOOA^§§ +2	15△ XT^†	L) LR^* 7.5 mm	6△ XT^†	o	x	x	x
				4△ LHT^∏	IO^** recession
No. 7	F/44	congenital/idiopathic	IOOA^§§ +2	15△ RHT^§	R) IO^** recession	6△ RHT^§	o	x	x	x
No. 8	M/8	congenital/idiopathic	IOOA^§§ +1	6△ RHT^§	R) IO^** recession	ortho	o	x	x	x
				4△ Eso^‡
No. 9^#	F/19	congenital/idiopathic	IOOA^§§ +2	20△ LHT^∏	L) IO^** recession	6△ LHT^§	o	x	x	x
				10△ XT^†	LR^* 3 mm	4△ XT^†
No. 10	M/21	congenital/idiopathic	IOOA^§§ +2	20△ XT^†	L) LR^* 8 mm	6△ LHT^§	o	x	x	x
				15△ LHT^∏	IO^** recession
No. 11	F/7	congenital/idiopathic	IOOA^§§ +2	20△ XT^†	R) LR^* 7.5 mm	4△ XT^†	o	x	x	x
				8△ RHT^§	IO^** recession
No. 12	M/20	congenital/idiopathic	IOOA^§§ +1	25△ XT^†^§	R) LR^* 8.25^**	6△ XT^†	o	o	x	x
				12△ RHT^§	IO^** recession
No. 13^#	M/19	congenital/idiopathic	IOOA^§§ +1	20△ XT^†^∏	L) LR^* 5 mm ^**	ortho	o	o	x	x
				15△ LHT^∏	IO^** recession
No. 14	M/6	congenital/idiopathic	IOOA^§§ +1	6△ LHT^∏	L) IO^** recession	ortho	o	x	x	x
No. 15	M/6	congenital/idiopathic	IOOA^§§ +2	15△ RHT^§8△ XT^†	R) IO^** recession	4△ RHT^§2△ XT^†	o	x	x	x
				8△ XT		2△ XT
No. 16	M/26	congenital/idiopathic	IOOA^§§ +3	30△ LHT^∏	L) IO^** recession	20△ LHT^§	x	x	x	x
				15△ XT^†	L) IO recession	10△ XT^†
No. 17^#	M/24	congenital/idiopathic	IOOA^§§ +2	20△ XT^†^§	R) LR 6.5^**	ortho	o	x	o	x
				12△ RHT^§	IO^** recession
No. 18	F/54	trauma	IOOA^§§ +1	8△ XT^†15△ RHT^§	R) IO^** recession	6△ RHT^§6△ XT^†	x	x	x	x
				15△ RHT^§		6△XT^†

Withdrawal of Postop head tilt: satisfaction measurement ≥ 4 grade; Inferior oblique recession was done 4 mm back and 2 mm temporal to inferior rectus insertion;

^* LR=lateral rectus recession

^† XT=exotropia;

^‡ Eso=esotropia;

^§ RHT=right hypertropia;

^∏ LHT =left hypertropia;

^# stereopsis≥70 sec of arc;

^** IO=inferior oblique;

^†† M=male;

^‡‡ F=female;

^§§ IOOA=inferior oblique overaction;

^∏∏ OP=operation;

^## Postop=postoperative;

^*** Preop=preoperative;

^††† SO=superior oblique.

Table 2.

Comparison between preoperative and postoperative conditions in primary position

	IOOA^* +1 (n=7)	IOOA^* +2 (n=10)	P-value
	Mean± SD	Mean± SD	P-value
Preoperative mean amount (PD^†)	11.1±3.76PD^†	11.6±5.27PD^†	0.847
Postoperative mean reduction (PD^†)	10.0±3.31PD^†	9.30±3.71PD^†	0.690

Statistical significance test was done by Mann-Whitney U-Test;

^* IOOA=Inferior oblique overaction;

^† PD=prism diopter.

Table 3.

The success rate depending on inferior oblique overaction

IOOA^* degree	Postoperative hyperdeviation			Success rate (%)
IOOA^* degree	Excellent (0∼3△)	Good (4∼7△)	Poor (>8△)	Success rate (%)
IOOA^*+1	6	1	0	100%
IOOA^*+2	6	4	0	100%
IOOA^*+3	0	0	1	0%

^* IOOA=inferior oblique overaction.

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