Inferior oblique overaction in trochlear nerve palsy: anterior transposition versus myectomy.

PURPOSE: To compare the effectiveness of inferior oblique myectomy and anterior transposition for correction of hypertropia in trochlear nerve palsy. METHODS: This retrospective study compares the surgical outcome of 40 patients with hypertropia secondary to trochlear nerve palsy who underwent either a unilateral myectomy or anterior transposition of the inferior oblique muscle. The primary outcome measure was the change in vertical deviation in primary gaze. RESULTS: A total of 40 patients with a mean age of 41 years were included. There was no statistically significant difference between groups (near preoperative hypertropia, P = 0.134 [Mann-Whitney test]). Of these, 19 underwent anterior transpositions and 21 myectomies. Both surgical techniques were successful at reducing levels of vertical deviation (anterior transposition, 89%; myectomy, 76%). However, the relative percentage reduction showed a statistically significant difference in postoperative outcomes, with anteriorization being more effective (anteriorization, 82%; myectomy 48%; P = 0.003). CONCLUSIONS: In this study cohort, anterior transposition was more effective than myectomy at correcting vertical deviation in patients with inferior oblique overaction secondary to trochlear nerve palsy.

Attention, mindwandering, and mood.

We tested the hypothesis that mindwandering and external distraction are both manifestations of a common state of reduced attention focus, and examined how both relate to reported level of happiness. We conducted real-time sampling of people's experience of mindwandering, irrelevant distraction (e.g. by music, phone, etc.), and happiness levels, in two studies with 524 people undertaking common daily-life activities. All irrelevant external distractions were positively correlated with mindwandering. Indeed mindwandering duration could be predicted from the reported duration of external distraction, when controlling for a range of background variables. An exploratory factor analysis of mindwandering and distraction reports suggested a single underlying construct. In addition, duration of irrelevant distraction by both mobile phones and mindwandering was significantly associated with reduced reported levels of happiness. The results are consistent with the hypothesis that that a state of reduced attention focus underlies both mindwandering and distractibility and clarify the link with happiness.