Individualized surgical treatment of congenital superior oblique paralysis_West China Medical Journal

Authors：

DONG Mingrong ^1,2 , WEI Hong ¹ ,  LIU Longqian ¹

1. Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Ophthalmology, NO.4 West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LIU Longqian, Email: b.q15651@hotmail.com

Keywords：

Strabismus; Congenital; Superior oblique palsy; Surgery

DOI：

10.7507/1002-0179.201809065

Video：

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Objective To investigate the efficacy of individualized surgical treatment on congenital superior oblique paralysis. Methods A total of 131 patients (180 eyes) undergoing surgery for congenital superior oblique palsy between October 2015 and January 2018 in West China Hospital of Sichuan University were reviewed. The clinical features, surgical methods and efficacy were analyzed. Results Among the 131 cases, 49 cases were bilateral congenital superior oblique palsy, and 82 cases were unilateral congenital superior oblique palsy; 94 cases were combined with horizontal strabismus; 17 cases (26 eyes) underwent inferior oblique recession, 53 cases (93 eyes) underwent superior oblique tuck, 4 cases underwent superior oblique tuck combined with contralateral superior rectus resection, 37 cases underwent superior oblique tuck combined with contralateral inferior rectus recession, 6 cases underwent inferior oblique recession combined with contralateral superior rectus resection, and 14 cases underwent inferior oblique transposition combined with contralateral superior rectus resection; 18 cases underwent horizontal strabismus correction at one stage, and 76 cases underwent horizontal strabismus correction at the second stage. After Surgery, there were 116 cases cured (88.55%), 15 cases improved (11.45%), and 0 case invalid. Conclusions The diagnosis of congenital superior oblique paralysis should be accurate. Individualized surgery should be designed according to the size and maximum orientation of the squint and the limitation or hyperactivity of the muscles in each diagnostic eye position.

Citation： DONG Mingrong, WEI Hong, LIU Longqian. Individualized surgical treatment of congenital superior oblique paralysis. West China Medical Journal, 2018, 33(11): 1367-1370. doi: 10.7507/1002-0179.201809065 Copy

1.	Kekunnaya R, Isenberg SJ. Effect of strabismus surgery on torticollis caused by congenital superior oblique palsy in young children. Indian J Ophthalmol, 2014, 62(3): 322-326.
2.	Yang HK, Kim JH, Hwang JM. Congenital superior oblique palsy and trochlear nerve absence: a clinical and radiological study. Ophthalmology, 2012, 119(1): 170-177.
3.	Khawam E, Ghazi N, Salti H. " Jampolsky syndrome”: superior rectus overaction-contracture syndrome: prevalence, characteristics, etiology and management. Binocul Vis Strabismus Q, 2000, 15(4): 331-342.
4.	中華眼科學會全國兒童弱視斜視防治學組. 斜視療效評價標準. 中國斜視與小兒眼科雜志, 1996, 4(4): 145.
5.	趙堪興. 斜弱視學. 北京: 人民衛生出版社, 2015: 97-102.
6.	Durnian JM, Marsh IB. Superior oblique tuck: its success as a single muscle treatment for selected cases of superior oblique palsy. Strabismus, 2011, 19(4): 133-137.
7.	Li Y, Zhao K. Superior oblique tucking for treatment of superior oblique palsy. J Pediatr Ophthalmol Strabismus, 2014, 51(4): 249-254.
8.	Sekero?lu HT, Sanac AS, Arslan U, et al. Superior oblique surgery: when and how?. Clin Ophthalmol, 2013, 7: 1571-1574.
9.	Keskinbora KH. Anterior transposition of the inferior oblique muscle in the treatment of unilateral superior oblique palsy. J Pediatr Ophthalmol Strabismus, 2010, 47(5): 304-307.
10.	Gr?f M, Lorenz B, Eckstein A, et al. Superior oblique tucking with versus without additional inferior oblique recession for acquired trochlear nerve palsy. Graefes Arch Clin Exp Ophthalmol, 2010, 248(2): 223-229.
11.	Kaeser PF, Klainguti G, Kolling GH. Inferior oblique muscle recession with and without superior oblique tendon tuck for treatment of unilateral congenital superior oblique palsy. J AAPOS, 2012, 16(1): 26-31.
12.	Miyata M, Shibata K, Hamasaki I, et al. Predictive factors for corrective effect of inferior rectus recession for congenital superior oblique palsy. Graefes Arch Clin Exp Ophthalmol, 2018, 256(2): 403-409.
13.	趙堪興. 斜視矯正術設計的思考. 中華眼科雜志, 2002, 38(8): 507-509.
14.	Dotan G, Roarty JD, Baker JD. Masked bilateral superior oblique palsy in children. J Pediatr Ophthalmol Strabismus, 2014, 51(6): 333-336.
15.	Erkan Turan K, Taylan Sekeroglu H, Sanac AS. Are we overlooking masked bilateral congenital superior oblique palsy in children: is it possible to diagnose before surgery?. Int Ophthalmol, 2018, 38(4): 1653-1657.
16.	陳麗萍, 張偉. 上斜肌折疊手術前后Bielschowsky歪頭試驗的變化. 中華眼科雜志, 2016, 52(8): 589-595.
17.	Chang MY, Coleman AL, Tseng VL, et al. Surgical interventions for vertical strabismus in superior oblique palsy. Cochrane Database Syst Rev, 2017, 27(11): CD012447.
18.	亢曉麗, 韋嚴. 關注上斜肌麻痹的臨床分型及治療的個性化設計. 中華眼科雜志, 2017, 53(12): 881-884.

1. Kekunnaya R, Isenberg SJ. Effect of strabismus surgery on torticollis caused by congenital superior oblique palsy in young children. Indian J Ophthalmol, 2014, 62(3): 322-326.
2. Yang HK, Kim JH, Hwang JM. Congenital superior oblique palsy and trochlear nerve absence: a clinical and radiological study. Ophthalmology, 2012, 119(1): 170-177.
3. Khawam E, Ghazi N, Salti H. " Jampolsky syndrome”: superior rectus overaction-contracture syndrome: prevalence, characteristics, etiology and management. Binocul Vis Strabismus Q, 2000, 15(4): 331-342.
4. 中華眼科學會全國兒童弱視斜視防治學組. 斜視療效評價標準. 中國斜視與小兒眼科雜志, 1996, 4(4): 145.
5. 趙堪興. 斜弱視學. 北京: 人民衛生出版社, 2015: 97-102.
6. Durnian JM, Marsh IB. Superior oblique tuck: its success as a single muscle treatment for selected cases of superior oblique palsy. Strabismus, 2011, 19(4): 133-137.
7. Li Y, Zhao K. Superior oblique tucking for treatment of superior oblique palsy. J Pediatr Ophthalmol Strabismus, 2014, 51(4): 249-254.
8. Sekero?lu HT, Sanac AS, Arslan U, et al. Superior oblique surgery: when and how?. Clin Ophthalmol, 2013, 7: 1571-1574.
9. Keskinbora KH. Anterior transposition of the inferior oblique muscle in the treatment of unilateral superior oblique palsy. J Pediatr Ophthalmol Strabismus, 2010, 47(5): 304-307.
10. Gr?f M, Lorenz B, Eckstein A, et al. Superior oblique tucking with versus without additional inferior oblique recession for acquired trochlear nerve palsy. Graefes Arch Clin Exp Ophthalmol, 2010, 248(2): 223-229.
11. Kaeser PF, Klainguti G, Kolling GH. Inferior oblique muscle recession with and without superior oblique tendon tuck for treatment of unilateral congenital superior oblique palsy. J AAPOS, 2012, 16(1): 26-31.
12. Miyata M, Shibata K, Hamasaki I, et al. Predictive factors for corrective effect of inferior rectus recession for congenital superior oblique palsy. Graefes Arch Clin Exp Ophthalmol, 2018, 256(2): 403-409.
13. 趙堪興. 斜視矯正術設計的思考. 中華眼科雜志, 2002, 38(8): 507-509.
14. Dotan G, Roarty JD, Baker JD. Masked bilateral superior oblique palsy in children. J Pediatr Ophthalmol Strabismus, 2014, 51(6): 333-336.
15. Erkan Turan K, Taylan Sekeroglu H, Sanac AS. Are we overlooking masked bilateral congenital superior oblique palsy in children: is it possible to diagnose before surgery?. Int Ophthalmol, 2018, 38(4): 1653-1657.
16. 陳麗萍, 張偉. 上斜肌折疊手術前后Bielschowsky歪頭試驗的變化. 中華眼科雜志, 2016, 52(8): 589-595.
17. Chang MY, Coleman AL, Tseng VL, et al. Surgical interventions for vertical strabismus in superior oblique palsy. Cochrane Database Syst Rev, 2017, 27(11): CD012447.
18. 亢曉麗, 韋嚴. 關注上斜肌麻痹的臨床分型及治療的個性化設計. 中華眼科雜志, 2017, 53(12): 881-884.

West China Medical Journal

Individualized surgical treatment of congenital superior oblique paralysis

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