Outcome of surgical management of superior oblique palsy: a study of 123 cases.

B. D. Simons, T. G. Saunders, R. M. Siatkowski, William J Feuer, A. M. Lavina, Hilda Capo, M. Muñoz, J. T. Flynn

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Abstract

PURPOSE: To determine the outcome of the surgical management of superior oblique palsy at our institution. SUBJECTS AND METHODS: Retrospective review of 123 patients who underwent surgical correction of superior oblique paresis at Bascom Palmer Eye Institute from 1976 to 1996. Subject-Patients: 67% were male and 33% female. The mean age at surgery was 30.5 years (range, 2-78 years). Etiologies of the pareses were trauma (34%), congenital (33%), and acquired/non-traumatic (33%). The mean angle of preoperative vertical deviation in primary gaze was 14.0 delta (range, 0-45 delta). Surgery: 109/123 (89%) patients underwent single muscle surgery. Of these 109, 57 had single oblique muscle surgery: a superior oblique tuck in 34/57 (60%); an inferior oblique weakening procedure in 22/57 (38%); and a Harada-Ito procedure in 1/57 (2%). The other 14 patients (11%) had bilateral surgery. RESULTS: The final postoperative vertical deviation in primary gaze was < or =3 PD in 60% of patients and < or =7 PD in 80%. The mean change in primary position vertical deviation postoperatively was 10.4 PD for distance and 13.0 PD for near. An "excellent" outcome (final vertical deviation &le3 PD in primary and reading gazes) was achieved most frequently in those patients with congenital pareses and isolated oblique muscle surgery. COMPLICATIONS: Clinically significant Brown's Syndrome occurred in 43/72 (60%) of those cases who had undergone a superior oblique tuck. The incidence of Brown's Syndrome was unrelated to tuck size. Reoperation was three times more likely to be necessary in traumatic cases than in congenital cases (35.0% vs 11.9%, p=0.02). CONCLUSIONS: Based on these results we recommend oblique muscle surgery as the initial procedure to correct superior oblique palsy when appropriate.

Original languageEnglish
Pages (from-to)273-282
Number of pages10
JournalBinocular vision & strabismus quarterly
Volume13
Issue number4
StatePublished - Dec 1 1998

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Paralysis
Paresis
Muscles
Reoperation
Reading
Incidence
Wounds and Injuries

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Ophthalmology

Cite this

Simons, B. D., Saunders, T. G., Siatkowski, R. M., Feuer, W. J., Lavina, A. M., Capo, H., ... Flynn, J. T. (1998). Outcome of surgical management of superior oblique palsy: a study of 123 cases. Binocular vision & strabismus quarterly, 13(4), 273-282.

Outcome of surgical management of superior oblique palsy : a study of 123 cases. / Simons, B. D.; Saunders, T. G.; Siatkowski, R. M.; Feuer, William J; Lavina, A. M.; Capo, Hilda; Muñoz, M.; Flynn, J. T.

In: Binocular vision & strabismus quarterly, Vol. 13, No. 4, 01.12.1998, p. 273-282.

Research output: Contribution to journalArticle

Simons, BD, Saunders, TG, Siatkowski, RM, Feuer, WJ, Lavina, AM, Capo, H, Muñoz, M & Flynn, JT 1998, 'Outcome of surgical management of superior oblique palsy: a study of 123 cases.', Binocular vision & strabismus quarterly, vol. 13, no. 4, pp. 273-282.
Simons BD, Saunders TG, Siatkowski RM, Feuer WJ, Lavina AM, Capo H et al. Outcome of surgical management of superior oblique palsy: a study of 123 cases. Binocular vision & strabismus quarterly. 1998 Dec 1;13(4):273-282.
Simons, B. D. ; Saunders, T. G. ; Siatkowski, R. M. ; Feuer, William J ; Lavina, A. M. ; Capo, Hilda ; Muñoz, M. ; Flynn, J. T. / Outcome of surgical management of superior oblique palsy : a study of 123 cases. In: Binocular vision & strabismus quarterly. 1998 ; Vol. 13, No. 4. pp. 273-282.
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abstract = "PURPOSE: To determine the outcome of the surgical management of superior oblique palsy at our institution. SUBJECTS AND METHODS: Retrospective review of 123 patients who underwent surgical correction of superior oblique paresis at Bascom Palmer Eye Institute from 1976 to 1996. Subject-Patients: 67{\%} were male and 33{\%} female. The mean age at surgery was 30.5 years (range, 2-78 years). Etiologies of the pareses were trauma (34{\%}), congenital (33{\%}), and acquired/non-traumatic (33{\%}). The mean angle of preoperative vertical deviation in primary gaze was 14.0 delta (range, 0-45 delta). Surgery: 109/123 (89{\%}) patients underwent single muscle surgery. Of these 109, 57 had single oblique muscle surgery: a superior oblique tuck in 34/57 (60{\%}); an inferior oblique weakening procedure in 22/57 (38{\%}); and a Harada-Ito procedure in 1/57 (2{\%}). The other 14 patients (11{\%}) had bilateral surgery. RESULTS: The final postoperative vertical deviation in primary gaze was < or =3 PD in 60{\%} of patients and < or =7 PD in 80{\%}. The mean change in primary position vertical deviation postoperatively was 10.4 PD for distance and 13.0 PD for near. An {"}excellent{"} outcome (final vertical deviation &le3 PD in primary and reading gazes) was achieved most frequently in those patients with congenital pareses and isolated oblique muscle surgery. COMPLICATIONS: Clinically significant Brown's Syndrome occurred in 43/72 (60{\%}) of those cases who had undergone a superior oblique tuck. The incidence of Brown's Syndrome was unrelated to tuck size. Reoperation was three times more likely to be necessary in traumatic cases than in congenital cases (35.0{\%} vs 11.9{\%}, p=0.02). CONCLUSIONS: Based on these results we recommend oblique muscle surgery as the initial procedure to correct superior oblique palsy when appropriate.",
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T2 - a study of 123 cases.

AU - Simons, B. D.

AU - Saunders, T. G.

AU - Siatkowski, R. M.

AU - Feuer, William J

AU - Lavina, A. M.

AU - Capo, Hilda

AU - Muñoz, M.

AU - Flynn, J. T.

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N2 - PURPOSE: To determine the outcome of the surgical management of superior oblique palsy at our institution. SUBJECTS AND METHODS: Retrospective review of 123 patients who underwent surgical correction of superior oblique paresis at Bascom Palmer Eye Institute from 1976 to 1996. Subject-Patients: 67% were male and 33% female. The mean age at surgery was 30.5 years (range, 2-78 years). Etiologies of the pareses were trauma (34%), congenital (33%), and acquired/non-traumatic (33%). The mean angle of preoperative vertical deviation in primary gaze was 14.0 delta (range, 0-45 delta). Surgery: 109/123 (89%) patients underwent single muscle surgery. Of these 109, 57 had single oblique muscle surgery: a superior oblique tuck in 34/57 (60%); an inferior oblique weakening procedure in 22/57 (38%); and a Harada-Ito procedure in 1/57 (2%). The other 14 patients (11%) had bilateral surgery. RESULTS: The final postoperative vertical deviation in primary gaze was < or =3 PD in 60% of patients and < or =7 PD in 80%. The mean change in primary position vertical deviation postoperatively was 10.4 PD for distance and 13.0 PD for near. An "excellent" outcome (final vertical deviation &le3 PD in primary and reading gazes) was achieved most frequently in those patients with congenital pareses and isolated oblique muscle surgery. COMPLICATIONS: Clinically significant Brown's Syndrome occurred in 43/72 (60%) of those cases who had undergone a superior oblique tuck. The incidence of Brown's Syndrome was unrelated to tuck size. Reoperation was three times more likely to be necessary in traumatic cases than in congenital cases (35.0% vs 11.9%, p=0.02). CONCLUSIONS: Based on these results we recommend oblique muscle surgery as the initial procedure to correct superior oblique palsy when appropriate.

AB - PURPOSE: To determine the outcome of the surgical management of superior oblique palsy at our institution. SUBJECTS AND METHODS: Retrospective review of 123 patients who underwent surgical correction of superior oblique paresis at Bascom Palmer Eye Institute from 1976 to 1996. Subject-Patients: 67% were male and 33% female. The mean age at surgery was 30.5 years (range, 2-78 years). Etiologies of the pareses were trauma (34%), congenital (33%), and acquired/non-traumatic (33%). The mean angle of preoperative vertical deviation in primary gaze was 14.0 delta (range, 0-45 delta). Surgery: 109/123 (89%) patients underwent single muscle surgery. Of these 109, 57 had single oblique muscle surgery: a superior oblique tuck in 34/57 (60%); an inferior oblique weakening procedure in 22/57 (38%); and a Harada-Ito procedure in 1/57 (2%). The other 14 patients (11%) had bilateral surgery. RESULTS: The final postoperative vertical deviation in primary gaze was < or =3 PD in 60% of patients and < or =7 PD in 80%. The mean change in primary position vertical deviation postoperatively was 10.4 PD for distance and 13.0 PD for near. An "excellent" outcome (final vertical deviation &le3 PD in primary and reading gazes) was achieved most frequently in those patients with congenital pareses and isolated oblique muscle surgery. COMPLICATIONS: Clinically significant Brown's Syndrome occurred in 43/72 (60%) of those cases who had undergone a superior oblique tuck. The incidence of Brown's Syndrome was unrelated to tuck size. Reoperation was three times more likely to be necessary in traumatic cases than in congenital cases (35.0% vs 11.9%, p=0.02). CONCLUSIONS: Based on these results we recommend oblique muscle surgery as the initial procedure to correct superior oblique palsy when appropriate.

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