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Moon and Kim: The Outcome of Graded Inferior Oblique Recession in the Congenital Unilateral Superior Oblique Palsy
Original Article

J Korean Ophthalmol Soc 2013;54(12):1882-1887.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.12.1882

The Outcome of Graded Inferior Oblique Recession in the Congenital Unilateral Superior Oblique Palsy

Sung Hyuk Moon, MD1, Myung Mi Kim, MD, PhD2,

1Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

2Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Myung Mi Kim, MD, PhD Department of Ophthalmology, Yeungnam University Medical Center, #170 Hyeonchung-ro, Nam-gu, Daegu 705-703, Korea, Tel: 82-53-620-3441, Fax: 82-53-626-5936, E-mail: mmk@med.yu.ac.kr

Received 8 February 201320 June 2013       Accepted 29 October 2013

Copyright © 2013 Korean Ophthalmological Society

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 examine changes in vertical deviation and improvement in head tilt after graded inferior oblique (IO) recession surgery in patients with congenital unilateral superior oblique palsy (SOP). Frequency of inferior oblique overaction (IOOA) or bilateral SOP in the contralateral eye after surgery was also investigated.

Methods

We retrospectively reviewed medical records of 65 patients who had undergone graded IO recession surgery in unilateral congenital SOP with at least 1 year of postoperative follow-up. Postoperative vertical deviation was classified as excellent (under 3 prism diopters, PD), good (4-7 PD) or poor (over 8 PD). The occurrence of IOOA was considered if more than 2 IOOAs were observed in the contralateral eye after surgery.

Results

Forty-five of the 65 patients (69%) obtained excellent results and 67.3% had improvement in head tilt after surgery. IOOA in the contralateral eye was not observed in any patients before surgery. Postoperative IOOA in the contralateral eye occurred in 9 patients (13.8%) and a diagnosis of masked bilateral SOP was made in 1 patient (1.5%).

Conclusions

The graded IO recession procedures are considered to be an effective surgical method for the treatment of unilateral congenital SOP. However, IOOA or masked bilateral SOP occurring in the contralateral eye was observed in 15.3% of the patients undergoing surgery.

Keywords: Head tilt, Inferior oblique overaction, Inferior oblique recession surgery, Masked bilateral superior oblique palsy, Superior oblique palsy

References

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Figure 1.
Drawing of the various recession points in the right eye. A point is 4 mm posterior and 4.4 mm temporal to the lateral border of the inferior rectus muscle insertion (Fink’s point). B point is 3 mm posterior and 2 mm temporal (Scheie- Parks point). C point is position of the inferotemporal vortex vein. LR=lateral rectus muscle; MR=medial rectus muscle; IR=inferior rectus muscle.
jkos-54-1882f1.tif
Table 1.
Age distribution of patients
Age (years) No. of patients (%)
≤2 27 (41.5)
3-5 15 (23.1)
6-10 12 (18.5)
≥11 11 (16.9)
Total 65 (100)
Table 2.
Surgical results after graded inferior oblique recession procedures
Type of operation Amount of hyperdeviation (PD)
 Amount of correction (PD)
Preoperative deviation Postoperative deviation at 1 year Deviation at final follow-up
IO rec. 8 mm (n = 7) 6.3 ± 4.5 0 0 6.3 ± 4.5 (0-14)
  10 mm (n = 40) 10.1 ± 11.7 2.7 ± 4.6 2.8 ± 5.6 11.3 ± 6.8 (0-25)
  14 mm (n = 18) 16.5 ± 12.2 3.8 ± 6.3 3.2 ± 5.7 14.8 ± 8.3 (0-30)

Values are presented as mean ± SD.

PD = prism diopters; IO rec. = inferior oblique muscle recession.

Table 3.
Classification of postoperative results after graded inferior oblique recession procedures
Type of operation Postoperative hyperdeviation
Excellent (0-3 PD) Good (4-7 PD) Poor (>8 PD)
IO rec. 8 mm (n = 7) 7 (100%) 0 (0%) 0 (0%)
  10 mm (n = 40) 27 (67.5%) 8 (20.0%) 5 (12.5%)
  14 mm (n = 18) 11 (61.1%) 3 (16.6%) 4 (22.2%)
Total (n = 65)   45 (69.2%) 11 (16.9%) 9 (13.8%)

PD = prism diopters; IO rec. = inferior oblique muscle recession.

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