Factors influencing the result of superior oblique weakening procedures in patients with superior oblique overaction in
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RESEARCH ARTICLE
Open Access
Factors influencing the result of superior oblique weakening procedures in patients with superior oblique overaction in horizontal strabismus Junwoo Chun and Seong-Joon Kim*
Abstract Background: Few studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction. Methods: The medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from + 0.5 to + 3, and pre- and postoperative grades were recorded for all patients. Results: The mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p < 0.001). Conclusions: There was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure. Keywords: Superior oblique overaction, Superior oblique weakening procedure, Dissociated vertical deviation
Background Superior oblique weakening procedures are used to treat superior oblique overaction, A- pattern strabismus occurs due to superior oblique overaction, inferior oblique muscle palsy, and Brown syndrome. Superior oblique weakening procedures include the superior oblique
* Correspondence: [email protected] Department of Ophthalmology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, Republic of Korea
muscle tenectomy, tenotomy, Z-tenotomy, silicone expander, and suture spacers. Earlier studies have reported a 65% success rate of superior oblique lengthening using silicone expanders in Brown syndrome, 67% success of using suture spacer in Brown syndrome, and 75% success rate of superior oblique lengthening procedures with silicone expanders in A-pattern strabismus [1–3]. Other studies have reported A-pattern collapse after a superior oblique weakening procedure in 60 to 84% of patients [4–6].
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, w
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