Simons BD. Saunders TG. Siatkowski RM. Feuer WJ. Lavina AM. Capo H.
Munoz M. Flynn JT. Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
Outcome of surgical management of superior
oblique palsy: a study of 123 cases.
Binocular Vision & Strabismus Quarterly. 13(4):273-82, 1998 Winter.
PURPOSE: To determine the outcome of the surgical management of
superior oblique palsy at
our institution. SUBJECTS AND METHODS: Retrospective review of 123 patients
who underwent surgical correction of superior
oblique paresis at Bascom Palmer Eye Institute from 1976 to
1996. Subject-Patients: 67% were male and 33% female. The mean age at surgery
was 30.5 years (range, 2-78 years). Etiologies of the pareses were trauma
(34%), congenital (33%), and acquired/non-traumatic (33%). The mean angle of
preoperative vertical deviation in primary gaze was 14.0 delta (range, 0-45
delta). Surgery: 109/123 (89%) patients underwent single muscle surgery. Of
these 109, 57 had single oblique muscle surgery: a
superior oblique tuck in 34/57 (60%); an
inferior oblique weakening procedure in 22/57 (38%); and a Harada-Ito procedure in 1/57 (2%). The other 14 patients (11%) had bilateral surgery. RESULTS: The final postoperative vertical deviation in primary gaze was < or =3 PD in 60% of patients and < or =7 PD in 80%. The mean change in primary position vertical deviation postoperatively was 10.4 PD for distance and 13.0 PD for near. An "excellent" outcome (final vertical deviation &le3 PD in primary and reading gazes) was achieved most frequently in those patients with congenital pareses and isolated oblique muscle surgery. COMPLICATIONS: Clinically significant Brown's Syndrome occurred in 43/72 (60%) of those cases who had undergone a superior oblique tuck. The incidence of Brown's Syndrome was unrelated to tuck size. Reoperation was three times more likely to be necessary in traumatic cases than in congenital cases (35.0% vs 11.9%, p=0.02). CONCLUSIONS: Based on these results we recommend oblique muscle surgery as the initial procedure to correct superior oblique palsy when appropriate.