Contralateral Superior Oblique Posterior Tenotomy (SOPT): A Primary Treatment for Diplopia in Downgaze Following Blowout Orbital Fracture

Autor:	Jonathan M. Durnian, Ian B. Marsh, Adesuwa Garrick, Gareth Hewitt
Rok vydání:	2013
Předmět:	Adult Male medicine.medical_specialty Time Factors Eye Movements genetic structures medicine.medical_treatment Tenotomy Surgical Flaps Young Adult Superior oblique muscle Diplopia medicine Humans Orbital Fracture Orbital Fractures Aged Retrospective Studies Aged 80 and over Vision Binocular business.industry Eye movement Middle Aged eye diseases Surgery Ophthalmology Oculomotor Muscle Treatment Outcome Oculomotor Muscles Female medicine.symptom business Orthoptic Binocular vision Follow-Up Studies
Zdroj:	Strabismus. 21:29-32
ISSN:	1744-5132 0927-3972
DOI:	10.3109/09273972.2012.762719
Popis:	Superior oblique posterior tenotomy (SOPT) is a recognized surgical treatment to weaken the depressor effect of the superior oblique muscle without causing excyclotropia. We analyzed its use in the management of diplopia in downgaze due to contralateral blowout orbital fracture.We performed a retrospective case note review of patients that had undergone an SOPT as a primary surgical option in the management of diplopia in down gaze caused by contralateral blowout orbital fracture. The study covered a 17-year period from 1993 and 2010. These cases had diplopia maximal to the side of the orbital blowout. Pre- and postoperative orthoptic measurements were compared. Surgical complications were noted.Five patients who fulfilled the entry criteria were identified. The mean follow-up period was 15.2 months (range 6-20 months). Preoperatively, the median |dev| was 2 prism diopters (PD) in primary position (range, 0-2) and 8 PD in downgaze (range, 2-18). At the final follow-up, the median |dev| in primary position was 0 PD (range, 0-2) and 2 PD in downgaze (range, 0-12). There were no significant differences pre- and postoperatively in both the primary position (p=0.19) or in downgaze (p=0.25) despite the large reduction in deviation size. Two patients needed a second procedure following SOPT. No patients complained of torsion, not in the primary position or in downgaze following the surgery.Contralateral SOPT can be a useful and simple primary treatment option for patients with moderate vertical deviations in downgaze to the same side of the orbital fracture. Larger deviations may require second surgeries. SOPT does not cause iatrogenic excyclotorsion and avoids surgery to a potentially much scarred inferior rectus area.
Databáze:	OpenAIRE
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