Torsion and clinical features in patients with acquired fourth cranial nerve palsy.

This retrospective study aimed to compare objective/subjective torsion and other clinical characteristics of patients with acquired trochlear nerve palsy. This study included 82 consecutive patients who were diagnosed with acquired fourth cranial nerve palsy between 2014 and 2021 and who were followed up for ≥ 6 months. The etiologies, ocular deviation, objective and subjective torsions were reviewed. The etiologies were classified as ischemic, traumatic, brain lesion, idiopathic, or other. The patients were classified into two groups according to the recovery state: full recovery and partial/no-recovery. We compared the torsion and clinical features based on the etiology and recovery state. The average age was 59.1 ± 11.1 years, and 58 (71.0%) of the patients were male. The most common cause was ischemic (n = 49, 59.7%) and other common causes included traumatic (n = 16, 19.5%), brain lesion (n = 8, 9.8%), idiopathic (n = 5, 6.1%) and others (n = 4, 4.9%). Of the 82 patients, 56 (68.3%) were assigned to the full recovery group, and 26 (31.7%) were assigned to the partial/no-recovery group. The average age and number of patients with ischemic causes of palsy were greater in the full recovery group (p = 0.026 and p < 0.000, respectively). The vertical deviation angle, tilted angle on the Lancaster red-green test (LRGT), proportion of patients who experienced subjective torsion on the LRGT, and head tilt were smaller in the full recovery group (p = 0.037, 0.042, 0.045, and 0.006, respectively). Ischemic trochlear nerve palsy, advanced age, a small deviation angle at the primary position, and few cases of excyclotorsion on LRGT were characteristic of the full recovery group of acquired unilateral trochlear nerve palsy patients.

Factors Associated with Surgical Outcomes after Bilateral Lateral Rectus Recession in Children with Intermittent Exotropia.

Backgroud: To analyze the factors associated with surgical outcomes after bilateral rectus recession (BLR) in children with intermittent exotropia (IXT). Methods: A retrospective study was performed on 125 patients who had all received preoperative patch treatment with a ≥1 year follow-up. The surgical outcomes were grouped as success (esodeviation ≤5 PD to exodeviation ≤10 PD) or failure (esodeviation >5 PD or exodeviation >10 PD) according to the angle of deviation at 1 year postoperatively. The patients' magnitude of exodeviation, near and distant stereoacuity, and 3-mo patch responses were assessed. The factors associated with the surgical outcomes were determined using univariate and multivariate analyses. Results: Of the 125 patients, 102 (81.6%) and 23 (18.4%) were assigned to the success and failure groups, respectively. According to the univariate analysis, the absence of anisometropia, a smaller preoperative near exodeviation, a better near stereopsis, a smaller magnitude of deviation on day 1 postoperatively, and response to patching were significantly associated with surgical success for IXT after 1 year. In the multivariate analysis, distant esotropic deviation on day 1 postoperatively and response to patching were the factors affecting successful surgical outcomes. Conclusions: Esotropic distant deviation on day 1 postoperatively is a prognostic factor for favorable surgical outcomes. Preoperative patching could be a factor influencing surgical success in children with IXT.