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@#AIM: To study the curative efficacy of different surgical procedures in the treatment of congenital unilateral monocular oblique paralysis and its effects on binocular vision function.<p>METHODS: Totally 82 children of congenital unilateral monocular oblique paralysis who received therapy from May 2016 to 2019 in our hospital were selected as research objects, operative plan was determined by the degree of hyperfunction of the inferior oblique muscle, the movement of the eyeball and the vertical obliquity of the eye position, the inferior oblique muscle tendon amputation(3 cases), partial inferior oblique muscle resection(63 cases), inferior oblique muscle recession(6 cases), posterior rectus muscle repair(4 cases), inferior oblique muscle weakening+contralateral/ipsilateral rectus muscle operation(5 cases), upper oblique folding(1 cases). The effects of different surgical procedures and the changes of binocular visual function, corrected visual acuity and compensatory head position before and after surgery were compared. <p>RESULTS: Compared with before surgery, the fusion function, hyperstereopsis, myopia, corrected visual acuity and compensatory head position were significantly improved after operation(<i>P</i><0.05); there was no significant difference in stereopsis between children with or without compensatory head position after operation(<i>P</i>>0.05). <p>CONCLUSION: Choosing different surgical methods according to the severity of congenital superior oblique paralysis has positive significance, which can improve the vision and compensating head position of children, and it's helpful to rebuild binocular vision function.
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@#AIM: To investigate the effect of anterior transposition of inferior oblique muscle on the treatment of dissociated vertical deviation(DVD)in children with inferior oblique overaction(IOOA)and unequal inferior oblique transposition of the treatment of IOOA with the eyes of the asymmetry of DVD efficacy, associated with the lower oblique hyperfunction DVD patients to provide more effective treatment. <p>METHODS: Eighty patients with hyperfunction who were treated in our hospital from January 2014 to December 2015 were randomly selected and treated with anterior transposition of inferior oblique muscle. Patients were followed up for 1 to 30mo. We compared the vertical incline at the original incline from far(5m), near(33cm)distance and IOOA degree before and after operations, and the correlation between the two. We also compared the vertical incline at the original incline from far(5m), near(33cm)distance and IOOA degree before and after operations in 30 eyes(20 patients)with bilateral asymmetry DVD and IOOA who received unequal inferior oblique transposition. The incidence of antielevation syndrome(AES)was observed after operations. <p>RESULTS: The mean prism diopters(PD)at 5m before operations was 19.5±0.15, the average PD after operations was 3.5±0.18, at 5m the original incline was 16±0.21PD. The mean PD at 33cm was 18.6±0.20 before operation, 4.5±0.26 after operations, and 14.1±0.16 at 33cm the original incline, the difference was statistically significant(<i>P</i><0.05). Preoperatively, inferior oblique muscle hyperfunction +2 and +3 was 50 eyes, + 1 was 20 eyes, and 12 eyes still showed inferior oblique muscle hyperfunction after operation, but the degree of hyperactivity was +1. There was a significant positive correlation between the degree of IOOA and the vertical inclination(33cm: <i>r</i>=0.554, <i>P</i><0.01; 5m: <i>r</i>=0.454, <i>P</i> <0.01). There were significant differences(<i>P</i><0.05)in the vertical incline in 20 patients(30 eyes)with bilateral asymmetry DVD and IOOA and the degree of IOOA was significantly lower. In contrast, 18 patients(24 eyes)underwent anterior transposition of the inferior oblique muscle had AES in different degrees, which had statistically significant difference(<i>P</i><0.05)compared with patients(30 eyes)with IOOA treated with unequal inferior oblique transposition. <p>CONCLUSION: Anterior transposition of the inferior oblique muscle has a good therapeutic effect on isolated vertical strabismus patients with inferior oblique hyperfunction. While the incidence of postoperative AES is low in patients received unequal inferior oblique muscle transposition.
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PURPOSE: To define the clinical characteristics of acute vertical strabismus in adults strabismus without known ocular and cranial external factors. METHODS: We performed a retrospective study of 72 adult patients who developed acute vertical strabismus without known ocular and cranial external factors such as trauma or operation and were followed up for at least 6 months. RESULTS: Undetermined cause (n = 41, 57%) was the most common etiology of acute vertical strabismus, followed by fourth cranial nerve palsy (n = 15, 20.8%), myasthenia gravis (n = 7, 9.7%), third cranial nerve palsy (n = 6, 8.3%), brain tumor (n = 2, 2.7%), and carotid-cavernous fistula (n = 1, 1.3%). The average vertical deviation at primary position was 7.2 prism diopter at initial visit. Thirty-eight (62.3%) patients recovered to orthophoria and 13 (21.3%) patients showed decreased level of diplopia. The average recovery period was 2.9 months. Ten cases remained as strabismus and 5 underwent surgery upon patient's request. CONCLUSIONS: Unknown cause was the most common diagonosis of adult acute vertical strabismus without known ocular and cranial external factors. In the present study, 62.3% of patients recovered to orthophoria and 83.6% recovered without surgical procedures.
Subject(s)
Adult , Humans , Brain Neoplasms , Diplopia , Fistula , General Surgery , Myasthenia Gravis , Oculomotor Nerve , Paralysis , Retrospective Studies , Strabismus , Trochlear Nerve Diseases , Wounds and InjuriesABSTRACT
PURPOSE: To report the clinical characteristics of patients undergoing reoperation after strabismus surgery during childhood. METHODS: Sixty-one patients who had undergone strabismus surgery in childhood and later reoperation were included. Age, visual acuity, type of strabismus at the first and second operations and postoperative angle of deviation were analyzed. The causes of reoperation were classified into recurrent, consecutive, or newly developed strabismus. Recurrent strabismus was defined as strabismus developed in the same direction after correction within 10 prism diopters (PD). Consecutive strabismus was defined as strabismus developed in the opposite direction after surgical overcorrection. RESULTS: The mean duration between the first operation and reoperation was 5.6 years. Recurrent exotropia was the most common cause of reoperation. The incidence of vertical strabismus was higher in reoperations than in first operations (4.9 vs 26.2%, P=0.020). Most incidences of vertical strabismus in the reoperation were newly developed after first operation for horizontal strabismus. At the last follow-up, 63.9% had ocular alignment within 10PD in the horizontal plane and within 8PD in the vertical plane. The frequency of amblyopia was 16.4%. CONCLUSIONS: Recurrent exotropia was the most common cause of reoperation for strabismus. The incidence of vertical strabismus was higher in reoperations than in first operations.
Subject(s)
Humans , Amblyopia , Esotropia , Exotropia , Follow-Up Studies , Incidence , Reoperation , Strabismus , Visual AcuityABSTRACT
In twenty five patients with vertical strabismus including dissociated vertical deviation, the auther measured the width of the superior rectus muscle insertion and the distances from posterior limbus to nasal, middle and temporal portion of the superior rectus insertion. The means of width of the insertion was 9.8mm +/- 0.92, the distances from the posterior limbus to the nasal, middle and temporal portion of the superior rectus insertion were 7.2mm +/- 0.92, 6.9mm +/- 0.7, and lO.8mm +/- 1.0 (in 7 cases) respectively. Statistically, the means of these measurements of DVD were not significantly different from other vertical strabismus patients. These reults suggest that the etiology of the DVD is not anatomic but neurogenic in origin.