ABSTRACT
PURPOSE: We wanted to examine the effect of graded recession and anteriorization of the inferior oblique muscle on patients suffering from unilateral superior oblique palsy. METHODS: Inferior oblique muscle graded recession and anteriorization were performed on twenty-two patients (22 eyes) with unilateral superior oblique palsy. The recession and anteriorization were matched to the degree of inferior oblique overaction and hypertropia. The inferior oblique muscle was attached 4 mm posterior to the temporal border of the inferior rectus muscle in six eyes, 3 mm posterior in five eyes, 2 mm posterior in five eyes, 1 mm posterior in five eyes, and parallel to the temporal border in one eye. RESULTS: The average angle of vertical deviation prior to surgery was 11.3+/-3.9 prism diopters (PD). The total average correction in the angle of vertical deviation after surgery was 10.8+/-3.8 PD. In the parallel group, the average reduction was 14 PD. After surgery, normal inferior oblique muscle action was seen in eighteen of twenty-two eyes (81.8%). CONCLUSIONS: Graded recession and anteriorization of the inferior oblique muscle is thought to be an effective surgical method to treat unilateral superior oblique palsy of less than 15 PD.
Subject(s)
Male , Humans , Female , Child, Preschool , Child , Adult , Adolescent , Treatment Outcome , Retrospective Studies , Ophthalmologic Surgical Procedures/methods , Oculomotor Nerve Diseases/physiopathology , Oculomotor Muscles/physiopathology , Follow-Up Studies , Eye Movements/physiologySubject(s)
Humans , Orthoptics/methods , Anterior Eye Segment/physiopathology , Cataract/complications , Surgery, Plastic/trends , Facial Injuries , Glaucoma/complications , Myasthenia Gravis , Ophthalmoplegia/physiopathology , Oculomotor Nerve Diseases/physiopathology , Physician's Role , Thyroid Diseases/complicationsABSTRACT
When the oculomotor nerve is completely paralyzed, the affected eye shows severe outward displacement and poor cosmetic appearance. Past results of many surgical procedures for oculomotor palsy have been generally unsatisfactory. We tried a new surgical approach experimentally, in which the disinserted lateral rectus muscle was used as an adductor by medial transposition of the muscle. Five adult cats underwent disinsertion of the medial rectus muscle of both eyes to induce iatrogenic medial rectus paralysis. The disinserted medial rectus was removed as far back as possible to prevent reattachment. Then, the right lateral rectus muscle was disinserted and passed beneath the superior rectus muscle and resutured to the sclera 4mm superoposterior to the medial rectus insertion site. After excision of the bilateral medial rectus, a large exotropia of an average 47.6 delta (42.0-55.5 delta) was induced. The medial transposition of the right lateral rectus produced an average 36.6 delta (24.8-45.8 delta) correction of the exotropia. A satisfactory cosmetic result was achieved by this procedure.