The surgical outcome of inferior oblique recession on bilateral superior oblique palsy in children.

OBJECTIVE: To study the surgical effects of bilateral graded inferior oblique muscle (IO) recession on the reduction of the V pattern deviation and severity of inferior oblique muscle overaction (IOOA) in children who had bilateral superior oblique muscle palsies (SOP) with secondary inferior oblique muscle overaction. MATERIAL AND METHOD: Seven patients who presented with bilateral SOP with secondary IOOA were included. All patients had V pattern deviation and bilateral graded IO recession was done. The data of age, sex, deviation in primary position, V pattern and severity of IOOA was recorded both pre- and post -operatively. The comparison of pre-operative and post-operative amount of V pattern and IOOA was analyzed with nonparametric statistical analysis. RESULTS: Four females and three males had the average age of 5.7 +/- 1.8 years old. The mean pre-operative severity of IOOA was + 3 and the mean pre-operative deviation of the V pattern was 36 +/- 11.4 prism diopters (PD). The mean post-operative severity of IOOA was + 0.4 and of V pattern deviation was 10.7 +/- 4.4 PD. Comparing the pre-operative and post-operative severity of lOOA and V pattern deviation by non-parametric statistical analysis and the result was statistically significant. CONCLUSION: Bilateral graded IO recession is an effective surgical procedure to reduce the V pattern and the severity of IOOA in the children who are suffering from bilateral SOP with secondary IOOA.

Intracranial tumors affecting visual system: 5-year review in Prasat Neurological Institute.

OBJECTIVES: To study the types of intracranial tumors with histological confirmation that impair visual system and to determine the neuro-ophthalmic manifestations in patients with intracranial tumors. MATERIAL AND METHOD: Retrospective review of patients with intracranial tumors who were pre-operatively examined by ophthalmologists in the neuro-ophthalmology unit, Prasat Neurological Institute. All patients had tissue pathology confirmation, and the authors excluded the patients with recurrence or post-operative status of intracranial tumors. RESULTS: Male to female ratio was 1:2.5 of 149 patients. The age onset was highest in the 4th to 5th decade. The three most common types of intracranial tumors were meningioma (45%), pituitary adenoma (32.9%), tumors of neuroepithelial tissues (6.7%) and craniopharyngioma (6.7%).Common neuro-ophthalmological symptoms were visual blur (88.6%) and proptosis (12.1%). In addition, common signs were visual field defect (80.5%), abnormal optic discs (69.7%), and relatively afferent pupillary defect (43.6%). Ninety percent of the patients had the visual difficulty symptom for less than 12 months, before the diagnosis of intracranial tumors. Fifty-nine percent of the patients presented with visual acuity 20/200 or worse, and 15.4% of the patients presented with no light perception (NLP). CONCLUSION: From the study, meningioma is the most common tumor that impairs the visual pathway structures followed by pituitary adenoma. Furthermore, decreased visual acuity, visual field defects, abnormal optic discs, and relatively afferent pupillary defect are the common neuro-ophthalmic features that should be carefully examined to avoid late detection of intracranial tumors.