1 / 38

Analysis of Results of Various Surgeries on the Superior Oblique

Analysis of Results of Various Surgeries on the Superior Oblique. KOWAL L MAHINDRAKAR A RVEEH, MELBOURNE. Preamble. Superior oblique surgeries are infrequent in Anglo-American strabismus Reputation for being difficult and prone to complications

hadar
Download Presentation

Analysis of Results of Various Surgeries on the Superior Oblique

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Analysis of Results of Various Surgeries on the Superior Oblique KOWAL L MAHINDRAKAR A RVEEH, MELBOURNE

  2. Preamble • Superior oblique surgeries are infrequent in Anglo-American strabismus • Reputation for being difficult and prone to complications • AIM: To examine the results of various superior oblique surgeries (single surgeon)

  3. Methods • Records of 28 patients who had SO surgeries* and who were seen between 2004 -08 were analysed *some had their surgeries outside this period

  4. Diagnostic groups • 1. Superior oblique paresis / palsy SOP • 2. Hypotropia • 3. Brown’s • 4. A pattern

  5. Typical Pre-op case

  6. RIO +, RSO -, RIR -

  7. SOP Full tendon width strengthening operation considered if: • Intra- op FDT shows significant unequivocal floppiness [‘..just keeps going’] • Usually: Coronal scan shows atrophy Usual operation: advancement / plication @ insertion till mild Brown’s created [can elevate 6 o’clock limbus ~3mm above the intercanthal horizon]

  8. Results – 4 pts with SO plication • 2 unilateral cong. SOP • 1 bilateral cong. SOP • 1 bilateral acquired SOP due to post. fossa lesion

  9. Unilateral Cong. SOP n=2 • Both had SO plication and Parks’ IO recess • One required re-plication • Both have improved AHP 3 yrs later • One has good ROSV with 100” stereo

  10. Bilateral cong SOP n=1 • Bilateral SO plication • Has large ROSV at 1 year • Torsion corrected from 10° excyclo to < 5° incyclo • Minimal residual hypertropia in R gaze (pre-op 20∆); none in L gaze (pre-op 12∆)

  11. Bilateral SOP 2ary to post. fossa lesion n=1 • Unilateral plication + bilateral IO recession + vertical R-R OU [!] • 13 years follow-up: good ROSV • SO plication corrected 10° of excyclotorsion (8° residual)

  12. Plication for SOP • In selected cases, a reliable and safe operation

  13. Diagnostic groups • 1. Superior oblique paresis / palsy SOP • 2. Hypotropia • 3. Brown’s • 4. A pattern

  14. Hypotropian=4 1-2y follow-up n = 2 Tenotomy • corrected hypo (7∆ and 15∆) • improved A pattern from 25 to 12 ∆ in one pt.

  15. Hypotropian=4 1-2y follow-up n =2: Recession – [posterior] transposition to 13mm from limbus & 2mm nasal to SR (Souza Dias) • corrected hypo (15 and 14∆) • improved A pattern from 25 ∆ to < 5∆

  16. Diagnostic groups • 1. Superior oblique paresis / palsy SOP • 2. Hypotropia • 3. Brown’s • 4. A pattern

  17. Results - Brown’s • 6 patients • Spacer, Tenotomy, Recession • 1-2 years follow-up

  18. Results - Brown’s • Spacer →no improvement (1 pt.) FDT was negative • SO tenotomy + IO recession →no improvement (1 pt.) • SO tenotomy + IO Rc + LR Rc→ Good range of movement (1pt.)

  19. Results - Brown’s • SO tenotomy + IO rec. + other SR faden → improved appearance (1 pt.) • SO spacer (later removed) + IO rec. + other SR faden → No AHP; large ROSV (1 pt.) • SO recession ~12mm → corrected AHP (1 pt.)

  20. Brown’s • These results are not as good as published series • Pathology may vary • 2ary effects [eg tight verticals] may come to dominate the clinical picture and obscure the original pathology

  21. Diagnostic groups • 1. Superior oblique paresis / palsy SOP • 2. Hypotropia • 3. Brown’s • 4. A pattern

  22. A pattern n=14 • 10 : Partial tendon weakening operation : bilateral SO posterior tenectomy [SOPT] • 4 : full tendon width weakening operation 1 full tendon width tenotomy 1 spacer 2 recession – transposition 1-3 y follow-up

  23. Posterior tenectomy SO

  24. Posterior tenectomy NOTE: WIDE SCATTER OF RESULTS From Souza Dias & Praeto Diaz

  25. Posterior tenectomy NOTE: WIDE SCATTER OF RESULTS From Souza Dias & Praeto Diaz

  26. SO Post. Tenectomy n=10 • 1-4 years follow-up • 2/10 patients improved completely • Max. correction 20 ∆

  27. SO Post. tenectomy • 3/10 patients had partial correction • Improvement varied from 10 – 12 ∆ 5/10 had partial or complete correction

  28. SO Post. tenectomy • 3 patients had no improvement • 2 patients : A pattern worse

  29. ‘A’ pattern – complete tenotomy n=1 • 2 years follow-up • ‘A’ pattern improved from 25 ∆ to 12 ∆ • Also corrected hypotropia of 7 ∆

  30. ‘A’ Pattern – SO spacer n=1 • 1 year follow-up • AHP resolved

  31. ‘A’ Pattern Recession – Transposition n=2 • One had correction of 70 ∆ !! • One had improvement in ‘A’ from 25 ∆ to < 5 ∆ + correction of 14 ∆ hypo

  32. Recession - transposition FAIRLY TIGHT RESULTS

  33. SO surgeries • One abandoned as no tendon was found

  34. Complications • One spacer: chronic inflammation and recurrence of Brown’s after temporary improvement • No lid problems

  35. Conclusions • Palsy → plication reliable [if well selected] • Hypotropia → good results from tenotomy, recess / transpose • ‘A’ pattern → Full tendon width procedure better than PTSO • PTSO → not reliable for ‘A’ pattern [but will not ‘bite’ you] • Brown’s → mixed results

  36. Pre-op (Centofanti Rec- trans)

  37. Pre-op (dula – tenotomy)

  38. Pre-op (dula tenotomy)

More Related