| Objective To investgate the effect of inferior oblique myotomy and superior oblique tucking on the vertical deviation of the primary position, Bielschowsky head tilt test, torsion,abnormal head posture,binocular vision function and their complications.Methods We reviewed the records of consecutive patients who had congenital unilateral superior oblique palsy in Tianjin Eye Hospital from February 2013 to September 2015. According to vertical deviation in the primary position, ocular motolity, objective cyclotorsion and abnormal head posture.22 patients underwent superior oblique tucking procedure. 25 patients underwent inferior oblique myotomy procedure. Vertical deviation in primary position was recorded pre-and postoperatively. Objective cyclotorsion was examined pre-operation, as well as 1 day and 3 monthes post-operation with fundus photograph. The photographs were delivered to a computer and then the fovea-disa angle(FDA) was measured by a software for drawing pictures. Bielschowsky head tilt test was evaluated quantitatively before and after the operation by the prism cover test while the patient fixated at 33 cm and 5 m on the small light target Α positive Bielschowsky head tilt test was defined as one in which the vertical deviation when the head tilt to the side of the paresis was at least 5. 0PD greater than that on tilt to the uninvolved side. Binocular vision function was assessed by synoptophore, Titmus was assessed before and after surgery. Head tilt was measured using a goniometer. During measurement, the patient fixated on a target. One arm of the goniometer was placed parallel to axis of the face, the other arm perpendicular to the floor. All statistical calculations were done with SPSS 17.0 software.Results 25 patients underwent the procedure of inferior oblique myotomy, the vertical deviation in the primary position was(12.04 ± 3.77) PD before the surgery, the vertical deviation in PP reduced to(3.52 ± 2.17) PD in the last follow-up visit. Vertical deviation in PP was decreased by(8.52 ± 2.67) PD.22 patients underwent the procedure of superior oblique tucking. The mean pre- and postoperative vertical deviation in primary position was(4.24± 1.72)PD and(2.05±1.36) PD, respectively. Vertical deviation in PP was reduced by(2.23 ± 1.91) PD. Two methods of operation in the primary position vertical gradient correction amount difference was statistically significant(F = 11.38, P(27)0.05), We found that there were no correlations between the amount of SO tuck and vertical deviation in primary position(Pearson correlation coefficient =0.235,P=0.258). In 25 cases of inferior oblique myotomy, the hyperdeviation of the paresised eye when the head tilted to the side of paresis side and uninvolved side difference was 10.00 PD ~ 28.00 PD,1 day after the operation was 2.00 PD ~ 14.00 PD, after 3 months was 2.00 PD ~ 12.00 PD. Preoperative and 1 day postoperative difference was statistically significant(P <0.05). Preoperative and 3 mongths postoperative difference was statistically significant(P <0.05). 1day after the surgery and 3 monthes postoperative difference was not statistically significant(P> 0.05). In the last follow-up visit, 6 patients Bielschowsky head tilt test became negative(24%), and 19 cases(76%) still remained positive. In 22 cases of superior oblique tucking, the hyperdeviation of the paresised eye when the head tilted to the side of paresis side and uninvolved side difference was 5.00 PD ~ 17.00 PD,,after 3 months was 0.00 PD ~ 14.00 PD. Preoperative and 1 day postoperative difference was statistically significant(P <0.05/3). Preoperative and 3 months postoperative difference was statistically significant(P <0.05/3). 1d after the surgery and 3 monthes postoperative difference was not statistically significant(P> 0.05/3). All patients Bielschowsky head tilt test was positive preoperatively. 3 months after the operation, 17 patients Bielschowsky head tilt test became negative(77.27%), and 5 cases stilled remained positive. All 47 cases Bielschowsky head tilt test was positive preoperatively. In 22 cases of patients underwent the procedure of superior oblique tucking, 5 patients Bielschowsky head tilt test was still positive, 17 cases of postoperative Bielschowsky head tilt test became negative. 25 patients with inferior oblique myotomy, 19 cases Bielschowsky head tilt test is still positive, 6 patients’ surgery Bielschowsky head tilt test became negative. Using Fisher’s exact test, the difference was statistically significant(P <0.05). It’s obvious that procedures of inferior oblique myotomy and superior oblique tucking had significant differences on Bielschowsky head tilt test. 3.25 cases of inferior oblique myotomy, The total FDA of two eyes was(22.67 ± 7.77), after 1-day was(15.12 ± 7.02), 3 months after operation was(15.94± 7.81). According to the results of ANOVA analysis, FDA between the preoperative and postoperative was statistically significant(F = 12.99, P <0.05). The preoperative and 1 day postoperative difference was statistically significant(P <0.05); The preoperative group and 3 months postoperative difference was statistically significant(P <0.05); 1 day after the operation and 3 months postoperative had no significant difference(P(29)0.05).22 cases of the superior oblique tucking, the FDA of the paresis eye was(9.55 ± 4.95), the contralateral eye was(8.08 ± 5.74), no statistically significant difference between the two eyes(P> 0.05). The total FDA of two eyes was(17.76± 6.26), after 1-day was(9.64± 7.03), 3 months after operation was(9.60± 7.81). According to the results of ANOVA analysis, FDA between the preoperative and postoperative was statistically significant(F = 23.634, P <0.05). The preoperative and 1 day postoperative difference was statistically significant(P <0.05); The preoperative group and 3 months postoperative difference was statistically significant(P <0.05); 1 day after the operation and 3 months postoperative had no significant difference(P(29) 0.05). Binocular vision in patients after the procedures of SO tucking and IO myotomy were improved. Two operations were effectively improving the compensatory head posture in patients. The incidence of complications between the two surgical procedures, patients with slightly Brown syndrome in the short term. After long-term follow-up, slightly Brown syndrome disappeared. Only on patient had diplopia when looking up in the extreme gaze of adducted. We found no complications in the patients who underwent IO myotomy.Conclusion 1.Inferior oblique myotomy procedure and superior oblique tucking procedure can be effectively corrected with overaction of the inferior oblique or underaction of superior oblique in congenital unilateral superior oblique palsy. According to the classification of Knapp, choose a different surgical approach, two surgical methods are significant differences in correcting vertical deviation in the primary position. 2..The SO tucking procedure and inferior oblique myotomy procedure were effective procedures to treat excyclotorsion for congenital unilateral SOP. 3.Two procedures of the operation ware no significant difference on the correction of exotorsion. Short-term effect was stable long-term effect needs further study. 4.Two surgical procedures can be effectively improved compensatory head position of the patient. There were significant differences on Bielschowsky head tilt test negative rate.SO tucking procedure postoperative Bielschowsky head tilt test negative rates significantly higher than the inferior oblique myotomy. 5.In this study, the amount of the superior oblique tucking was conservative. We suggest that an initial overcorrection may aid in long-term success of this procedure. |
PDF Full Text Request