Korean J Ophthalmol.  2012 Aug;26(4):285-289. 10.3341/kjo.2012.26.4.285.

Superior Rectus Muscle Recession for Residual Head Tilt after Inferior Oblique Muscle Weakening in Superior Oblique Palsy

• Ahn SJ
• Choi J
• Kim SJ
• Yu YS

• KMID: 1387396
• DOI: http://doi.org/10.3341/kjo.2012.26.4.285

Abstract

PURPOSE
Residual head tilt has been reported in patients with superior oblique muscle palsy (SOP) after surgery to weaken the inferior oblique (IO) muscle. The treatments for these patients have not received appropriate attention. In this study, we evaluated the superior rectus (SR) muscle recession as a surgical treatment.
METHODS
The medical records of 12 patients with SOP were retrospectively reviewed. Each of these patients had unilateral SR muscle recession for residual head tilt after IO muscle weakening due to SOP. The residual torticollis was classified into three groups on the basis of severity: mild, moderate, or severe. Both IO muscle overaction and vertical deviation, features of SOP, were evaluated in all patients. The severity of the preoperative and postoperative torticollis and vertical deviation were compared using a paired t-test and Fisher's exact test.
RESULTS
The torticollis improved in nine of 12 (75%) patients after SR muscle recession. The difference between the preoperative and postoperative severity of torticollis was statistically significant (p = 0.0008). After surgery, the mean vertical deviation was significantly reduced from 12.4 prism diopters to 1.3 prism diopters (p = 0.0003).
CONCLUSIONS
Unilateral SR muscle recession is an effective method to correct residual head tilt after IO muscle weakening in patients with SOP. This surgical procedure is believed to decrease head tilt by reducing the vertical deviation and thereby the compensatory head tilt.

Keyword

Superior oblique palsy; Superior rectus; Torticollis

MeSH Terms

Adolescent
Adult
Child
Child, Preschool
Diplopia/*surgery
Female
Head Movements
Humans
Infant
Male
Oculomotor Muscles/*surgery
Retrospective Studies
Strabismus/*surgery
Torticollis/*surgery
Treatment Outcome
Trochlear Nerve Diseases/*surgery

Reference

1. Helveston EM, Mora JS, Lipsky SN, et al. Surgical treatment of superior oblique palsy. Trans Am Ophthalmol Soc. 1996. 94:315–328.

2. Simons BD, Saunders TG, Siatkowski RM, et al. Outcome of surgical management of superior oblique palsy: a study of 123 cases. Binocul Vis Strabismus Q. 1998. 13:273–282.

3. Toosi SH, von Noorden GK. Effect of isolated inferior oblique muscle myectomy in the management of superior oblique muscle palsy. Am J Ophthalmol. 1979. 88(3 Pt 2):602–608.

4. Von Noorden GK, Murray E, Wong SY. Superior oblique paralysis. A review of 270 cases. Arch Ophthalmol. 1986. 104:1771–1776.

5. Davis AR, Dawson E, Lee JP. Residual symptomatic superior oblique palsy. Strabismus. 2007. 15:69–77.

6. Lau FH, Fan DS, Sun KK, et al. Residual torticollis in patients after strabismus surgery for congenital superior oblique palsy. Br J Ophthalmol. 2009. 93:1616–1619.

7. Madigan WP Jr, Katz NN. Ocular torsion-direct measurement with indirect ophthalmoscope and protractor. J Pediatr Ophthalmol Strabismus. 1992. 29:171–174.

8. Graf M. Diagnosis and treatment of trochlear nerve palsy. Klin Monbl Augenheilkd. 2009. 226:806–811.

9. Knapp P. First annual Richard G. Scobee memorial lecture. Diagnosis and surgical treatment of hypertropia. Am Orthopt J. 1971. 21:29–37.

10. Knapp P, Moore S. Diagnosis and surgical options in superior oblique surgery. Int Ophthalmol Clin. 1976. 16:137–149.

11. Nishimura JK, Rosenbaum AL. The long-term torsion effect of the adjustable Harada-Ito procedure. J AAPOS. 2002. 6:141–144.

12. Ameri A, Anvari F, Jafari AK, et al. Intraoperative adjustable suture surgery for excyclotorsion: a modification of the harada-ito procedure. J Pediatr Ophthalmol Strabismus. 2009. 46:368–371.

13. Molinari A, Ugrin MC. Frequency of the superior rectus muscle overaction/contracture syndrome in unilateral fourth nerve palsy. J AAPOS. 2009. 13:571–574.

14. Jampolsky A. Superior rectus overaction/contracture syndrome. 1998. Buenos Aires: Ciba Vision, Novartis;193–206.

15. Pacheco EM, Guyton DL, Repka MX. Changes in eyelid position accompanying vertical rectus muscle surgery and prevention of lower lid retraction with adjustable surgery. J Pediatr Ophthalmol Strabismus. 1992. 29:265–272.

16. Kushner BJ. A surgical procedure to minimize lower-eyelid retraction with inferior rectus recession. Arch Ophthalmol. 1992. 110:1011–1014.