Comparison of anterior transposition and recession of the inferior oblique muscle in unilateral superior oblique paresis.

PURPOSE: Both anterior transposition and graded recession have been shown to be effective procedures in weakening the inferior oblique muscle. Anterior transposition may work in part by converting the inferior oblique muscle from an elevator to a depressor of the globe. In theory, this would be useful in treating the inferior oblique overaction associated with superior oblique paresis. We compared inferior oblique recession and anterior transposition for the surgical correction of Knapp's class III unilateral superior oblique paresis. METHODS: Four patients underwent 14 mm recession, and five underwent anterior transposition of the inferior oblique muscle for the hypertropia in superior oblique paresis. Prism cover test measurements were made in all cardinal fields of gaze and were compared before and after operation between the two groups. RESULTS: The mean preoperative hyperdeviation in the primary position was 12 prism diopters in the recession group and 15 prism diopters in the anterior transposition group. The mean postoperative hyperdeviation was 1 prism diopter in the recession group and 3 prism diopters in the anterior transposition group. Postoperative results in the inferior oblique field of action demonstrated a mean 3 prism diopter hypertropia in the recession group and a 2 prism diopter hypotropia in the anterior transposition group. CONCLUSIONS: Anterior transposition and graded recession gave similar results in correcting the primary position hyperdeviation in Knapp's class III superior oblique paresis. Both procedures also markedly improved the hyperdeviation in the field of action of the inferior oblique muscle and superior oblique muscle. However, anterior transposition was more likely to result in postoperative hypodeviation in upgaze.

Diplopia following blepharoplasty.

The complication of extraocular muscle palsy following blepharoplasty is rare. In a review of 920 blepharoplasties at Manhattan Eye, Ear and Throat Hospital, three well-documented cases of diplopia following blepharoplasty could be found. Only one of these cases resolved within two months postoperatively. The explanation offered for this phenomenon is a Volkmann type contracture of the extraocular muscles following edema and hemorrhage into the muscle sheath.

The surgical management of intermittent exotropia in adults.

Most studies of intermittent exotropia deal primarily with children. However, the manifestations of this disorder in adults differ considerably from those in children. The case records of 44 adults (ages 15-70) who underwent surgery for intermittent exotropia were analyzed. These patients experienced a variety of preoperative symptoms including diplopia, headache, difficulty with reading, and ocular fatigue or pain. Cosmesis was a rare presenting complaint. The authors recommend that surgery in adults be conservative, aiming at slight undercorrection. Surgical management was successful in 41 of 44 patients. All patients with postoperative exodeviations under 15 delta had complete resolution of symptoms. Most patients with larger residual exodeviations did not improve symptomatically; patients with postoperative exodeviations tended to experience persistent diplopia.

Visual acuity and binocularity in unilateral high myopia.

Thirty-eight patients with unilateral high myopia ranging from 5 to 19 diopters were followed up for a median of two years. All were treated with full-spectacle correction and most had occlusion. When initially examined one patient (3%) had visual acuity of 6/12 (20/40) or better, four patients (12%) had central fusion, and 24 patients (63%) were phoric. At the conclusion of the study 12 patients (32%) had visual acuities of 6/12 (20/40) or better, 17 patients (45%) had central fusion, and 29 patients (76%) were phoric. Age at the start of treatment was not a factor in the versely affect the response to amblyopia was inversely related to both final fusion and final visual acuity.

Ocular manifestations and treatment of hemifacial atrophy.

Enophthalmos, flattening of the maxilla that may progress to inferior orbital rim and floor defects, eyelid atrophy, and slight relative hypotony occurred in patients with hemifacial atrophy. Less common manifestations included pupillary and iris abnormalities, vertical muscle imbalances, and retinal changes. The prognosis for vision was good. Fluid silicone injection was the major modality in treatment and the results were generally excellent.

Cyclic esotropia developing after sttstrabismus surgery.

Cyclic or alternate-day esotropia developed in a patient following strabismus surgery for intermittent exotropia, which resulted in a small overresponse or overcorrection. Surgery, aimed at the deviation on the esotropic days, resulted in binocularity and loss of the cyclic pattern.