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Purpose: To evaluate the outcome of strabismus surgery for congenital superior oblique palsy (SOP) in relation to correction of head tilt and hypertropia. The cohort of patients mainly involved very young children. This is the first study to use a standardized instrument to objectively measure torticollis before and after surgery. Materials and Methods: A non‑comparative interventional case series of 13 cases of congenital superior oblique palsy with head tilt, who underwent simultaneous superior oblique tuck and inferior oblique recession between Jan 2000 and Dec 2008, were studied. Results: The mean duration of SOP until surgery was 36.8 months. Of the 12 unilateral cases, 8 were right‑sided. Mean follow‑up period was 17 months (range 7‑36). The outcome was determined at the last follow‑up. Mean pre‑and post‑operative hypertropia (p.d.) in forced primary position was 19 ± 7 and 2 ± 6, respectively (P < 0.0001). The head tilt reduced from mean of 17 ± 9 to 2 ± 2 degrees (P < 0.0001). Success, defined as hypertropia <5 PD and head tilt less than 5 degrees, was achieved in 69% (9/13. C.I. 42‑88%) and 85% (11/13. C.I. 56‑96%), respectively. The success rate for achieving both criteria was 61.5% (C.I. 35‑88%). Five patients required additional surgery; usually a contralateral inferior rectus muscle recession, which was successful in all cases. One case developed asymptomatic Brown syndrome (7.69% ‑ C.I. 6.7‑22.2). Conclusions: Simultaneous superior oblique tuck and inferior oblique muscle recession can successfully treat selected cases of congenital superior oblique palsy. About one‑third required an additional procedure, which led to total normalization of the head position.
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Objective To evaluate the clinical application and the therapeutic effect of the Fresnel press-on prism for children ocular torticollis.Design Retrospective case series.Participants 64 patients with ocular torticollis.Methods All the patients with ocular torticollis wore Fresnel press-on prism on glasses for 6-12 months to correct small angle vertical paralytic heterotropia.Main Outcome Measures Changes of abnormal head position and stereoscopic vision when naked and glasses-wearing.Results Fresnel press-on prism could provide an improvement in the correction of symptoms in children ocular torticollis.58 patients(90.6%) had improvement of abnormal head position and three-grade binocular vision.All 55 cases(100.0%)matching examination after wearing prism showed simultaneous perception,52 eases(94.5%)had fusion,and 50 cases(90.9%)had stereoscopic vision.Chi square test showed significant difference from pre-wearing prism(P
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A 31-years-old female presented with left eyelid, canalicular, and conjunctival lacerations after struck by a glass bottle.She had left hypertropia and limitation of depression.Primary repairs of left eyelid, canalicular, and conjunctival laceration were performed that day.After two weeks, the explorative operation was done because of the inability of depression of left eye. We identified the transection of inferior rectus muscle, and repaired it.Three months after second operation, there were 12 prism diopters of left hyper-tropia, 12 prism diopters of left exotropia in the primary position, and 20 prism diopters of left hypertropia in left down gaze.Double Maddox rod testing revealed 6degrees of left incyclotropia, and she presented head tilt to the left. Four months after second operation, 5 mm recession of left superior rectus muscle was done.Postoperatively, she had nearly orthotropia in primary position, but 10 prism diopters in left downgaze.She had only 2 degrees of left incyclotropia, and showed the improvement of ocular torticollis.