Surgical Treatment Options According to Inferior Oblique Hyperfunction in Superior Oblique Palsy

Abstract

Objective: To evaluate comparatively the outcomes of different types of operations performed according to clinical examination and distinct clinical types of the patients who were diagnosed as superior oblique palsy (SOP). Material and Methods: A total of 32 patients who were followed up in Strabismus Section of Cerrahpasa Medical Faculty Department of Ophtalmology were enrolled in the study and evaluated prospectively. Subjects were divided into four groups according to surgical techniques. The first group (n=12): Patients whose inferior oblique hyperfunction (IOH) was +++ underwent anterior transposition of the inferior oblique (ATIO). The second group (n=9): Patients whose IOH was + underwent 8 mm of inferior oblique recession (IOR), ++ underwent 10 mm of inferior oblique recession (IOR). The third group (n=6): Patients whose IOH was ++++ underwent inferior oblique myectomy (IOM). The fourth group (n=5): Patients who had superior oblique (SO) hypofunction without IOH and patients whose SO tendon was detected to be loose in forced duction test underwent 6-12 mm of SO tucking. Results: Of the subjects, 17 were males and 15 were females. Mean age was 16.41 +/- 11.91. The right eye was involved in 15 cases, the left eye was involved in 15 cases and two cases were involved bilaterally. Of the SOP cases, 24 were congenital and eight were acquired in origin. Six of the acquired SOP cases were related to trauma and two were related to intracranial tumor. A statistically significant decrease was detected in IOH in the first three groups compared to preoperative status (p<0.05). Abnormal head position decreased in four groups postoperatively but a statistically significant decrease was only seen in TOR group (p=0,031), however a statistically significant difference was not found in stereopsis (p=0.076). Conclusion: ATIO and IOM methods were found to have similar effectiveness in terms of IOH correction. Surgical treatment was found to be effective in eliminating abnormal head position in SOP however a significant difference was not found in stereopsis postoperatively. It was concluded that presence of < 12 prism dioptry horizontal strabismus accompany with SOP did not constitute a definite indication for performing surgery to the horizontal muscle in the first session that surgery was done on the vertical muscle.