![]() ![]() ![]() ![]() The mean age of these patients was 4.2 ± 1.3 (3–43) years. Of the ten patients (six male, four female) with A pattern, six (60.0%) were unilaterally and four (40.0%) were bilaterally operated. The amount of torsion (median 6 degrees versus 2 degrees, P = 0.02, in nine of eleven patients) and abnormal head position (median 25 degrees versus 10 degrees, P = 0.03) was found to be significantly decreased after superior oblique surgery. Median preoperative vertical deviation was 14 (8–30) ∆ whereas the median postoperative vertical deviation was 4 (0–25) ∆ in primary position (P = 0.01). The sole surgery was superior oblique tendon tuck for all eleven patients. The mean age of these patients was 17.2 ± 14.8 (2–45) years. Of nine unilateral cases, two were traumatic palsy and the rest were congenital. Of eleven patients (seven male, four female) with fourth nerve palsy, nine had unilateral and two had bilateral involvement. The degree of abnormal head position trended towards a decrease after surgery (median 20 degrees versus 0 degrees, P = 0.04). The median preoperative vertical deviation was 12 (10–30) ∆ and this was significantly decreased after surgery (median postoperative vertical deviation was 0 ∆, P = 0.01). The mean age of these patients was 8.2 ± 7.1 (2–27) years. Of the 19 Brown syndrome patients (six males and 13 female), 17 (89.4%) patients were unilateral and unilaterally operated and two (10.6%) were bilateral and bilaterally operated. There were 19 patients (47.5%) with Brown syndrome, 11 (27.5%) with fourth nerve palsy, and ten with A pattern (25.0%). Review of medical records identified a total of 40 patients (20 male, 20 female) with a median age of 6 (2–45) years. ![]() The secondary outcome measure was the result of surgery. The primary outcome measures were the type of strabismus and the type of superior oblique muscle surgery. The final visit was at six months after superior oblique muscle surgery for all patients.Īmong patients with fourth nerve palsy, only those eligible for superior oblique surgery in terms of the main surgical indication (clinically significant superior oblique muscle underaction) were enrolled in the study. In the event of fourth nerve palsy, the amount of superior oblique tendon tuck was set after performing a forced duction test to prevent iatrogenic Brown syndrome. An exaggerated forced duction test was performed for all patients to rule out the presence of any remnant of superior oblique muscle. The superior oblique tendon was identified and cut in its sheath after opening of the conjunctiva nasally to the superior rectus muscle without damaging the neighboring tissue, whereas it was identified and cut temporally in patients with A pattern. The surgical choice made by the surgeons for Brown syndrome was intrasheath nasal tenotomy. The abnormal head position was measured using an orthopedic goniometer. All of the surgeries were performed in theater under general anesthesia after a forced duction test had been performed for both eyes. Vertical deviations were measured by prism cover test or Krimsky test.ĭiagnosis of superior oblique palsy was made on the basis of a positive three-step test, subjective ocular torsion measurement, Hess chart and synoptophore measurements. Visual acuity was assessed using the Snellen or Lea chart. The clinical characteristics of the patients, including presence of patterns, amount of vertical deviation (∆), subjective torsions, and the main diagnosis leading to surgery, were recorded, as well as the type of surgery and postoperative measurements. The patients were enrolled in the study according to the following inclusion criteria: having undergone superior oblique muscle surgery as a sole procedure, reliable orthoptic measurements, and a postoperative visit six months after the operation. The study was carried out in full accord with the principles laid out in the Declaration of Helsinki, and approval of the institutional review board was obtained. This retrospective study included patients who had undergone superior oblique muscle surgery to either weaken or strengthen the muscle between January 2007 and May 2012 at Hacettepe University School of Medicine Department of Ophthalmology, Strabismus Section. ![]()
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