Ipsilateral gaze deviation as a risk factor for surgical overcorrection in two-muscle surgery for unilateral superior oblique palsy.

Autor: Nash DL; Department of Ophthalmology, Gundersen Health System, La Crosse, Wisconsin. Electronic address: David.Loring.Nash@gmail.com., Diehl NN; Mayo Clinic Division of Biostatistics, Jacksonville, Florida., Mohney BG; Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
Jazyk: angličtina
Zdroj: Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus [J AAPOS] 2020 Oct; Vol. 24 (5), pp. 272.e1-272.e4. Date of Electronic Publication: 2020 Sep 18.
DOI: 10.1016/j.jaapos.2020.05.011
Abstrakt: Purpose: To investigate the angle of deviation in various gaze positions as a risk factor for overcorrection of moderate-angle unilateral trochlear nerve palsies treated with two-muscle surgery.
Methods: The medical records of consecutive patients with presumed unilateral moderate-angle trochlear nerve palsy who underwent two-muscle surgery were retrospectively reviewed. Patients with overcorrection, defined as reversal of hyperdeviation by prism alternate cover testing at distance (straight ahead) or near measured at 6 weeks, were compared to non-overcorrected patients for their preoperative torsion and ocular alignment at near and distance.
Results: A total of 45 patients (age range, 12-77 years; 24 [53%] males) with deviation ranging from 14 Δ to 25 Δ in primary position underwent two-muscle surgery, of whom 8 (18%) experienced surgical overcorrection by 6 weeks' follow-up. The preoperative angle of deviation was similar between overcorrected and non-overcorrected patients for eight of nine cardinal distance positions and near gaze; however, patients with smaller deviations in ipsilateral gaze were more likely to be overcorrected with two-muscle surgery (8.5 vs 16.0 [P = 0.029]). Cut point analysis determined that an ipsilateral gaze of ≤9 Δ was significantly associated with overcorrection. Greater lateral incomitance also trended toward overcorrection (15.0 vs 9.0 [P = 0.059]). Torsion was not a clinically significant indicator of overcorrection (3.5 vs 6 [P = 0.083]).
Conclusions: A preoperative ipsilateral angle of ≤9 Δ was associated with overcorrection in patients undergoing two-muscle surgery for moderate angle unilateral trochlear nerve palsies.
(Copyright © 2020 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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