Surgical results of patients with unilateral superior oblique palsy presenting with large hypertropias.

Purpose: Surgical management of superior oblique palsy (SOP) is challenging because of combined vertical, horizontal, and torsional misalignment. The authors report the surgical results of patients with large primary position hypertropias (> 20 prism diopters [PD]) due to unilateral SOP.

Methods: Criteria for success included correction of the anomalous head posture, primary position alignment between orthotropia and 6 PD of undercorrection, and no reoperation required for residual deviations in any direction of gaze.

Does inferior oblique recession cause overcorrections in laterally incomitant small hypertropias due to superior oblique palsy?

Aim: To evaluate the effects of inferior oblique muscle recession (IOR) in cases of laterally incomitant hypertropia <10 prism dioptres (PD) in central gaze thact 2t are clinically consistent with superior oblique palsy (SOP).

Methods: We retrospectively reviewed patients with SOP and hypertropias <10 PD in central gaze who underwent graded IOR. Primary outcomes were reduction of lateral incomitance and number of overcorrections in central gaze.

Medial rectus recession after vertical rectus transposition in patients with esotropic Duane syndrome.

Objective: To describe preoperative characteristics and postoperative results among patients with esotropic Duane syndrome who underwent vertical rectus transposition with vs without subsequent medial rectus recession (MRR).

Methods: Clinical records were compared of patients with esotropic Duane syndrome who underwent vertical rectus transposition with (study group) vs without (control group) subsequent MRR.

Results: Twenty-three study group members and 26 control group members were identified.

Binocular visual function in patients with Boston type I keratoprostheses.

Purpose: To report the postoperative binocular function of patients with Boston type I keratoprostheses implantation for unilateral visual impairment.

Methods: Seventeen patients who underwent implantation of a Boston type I keratoprosthesis and had a best-corrected visual acuity better than 20/50 in the contralateral eye before surgery were evaluated. All subjects prospectively underwent sensory testing of binocular function including Bagolini lenses, Worth-4-dot test, stereoacuity at distance and near, and double Maddox rods.

Long-term results of the surgical management of intermittent exotropia.

Purpose: To examine long-term surgical success rates (>10 years) for patients with intermittent exotropia and the risk factors for failure of surgery in these patients.

Methods: An attempt was made to contact all patients who underwent surgical treatment for intermittent exotropia between the years of 1970 to 1998 with a minimum postoperative follow-up of 10 years. Each patient underwent a detailed sensory and motor examination, including measurements of near and distance stereoacuity, cover testing, and ocular rotations.

Decreased postoperative drift in intermittent exotropia associated with A and V patterns.

Introduction: Few data exist concerning postoperative drift in patients with intermittent exotropia who have coexistent A or V patterns. In addition, the impacts of pattern collapse and surgical method on postoperative drift have not been well addressed.

Methods: We retrospectively reviewed the records of 132 patients who had surgery for intermittent exotropia and had >or=6 months' follow-up.

Management of vertical deviations after vertical rectus transposition surgery.

Purpose: To describe options for the management of vertical deviations after vertical rectus muscle transposition surgery (VRT).

Methods: Retrospective case series including 7 children who underwent VRT for esotropic Duane syndrome and developed the complication of a vertical deviation.

Results: Eighty-two consecutive children underwent VRT for Duane syndrome.

Lemierre's syndrome with fourth nerve palsy.

Lemierre's syndrome is characterized by acute oropharyngeal infection with secondary internal jugular vein thrombophlebitis and subsequent metastatic infections. The anaerobe Fusobacterium necrophorum is the usual etiologic agent, although other microorganisms, including Streptococcus, Staphylococcus, Enterococcus, Bacteroides, and Lactobacilli, may be present alone or in combination with F. necrophorum.

High-resolution magnetic resonance imaging demonstrates reduced inferior oblique muscle size in isolated inferior oblique palsy.

Purpose: The diagnosis of isolated inferior oblique muscle palsy is controversial for 2 reasons: first, clinical findings seem inconsistent with our current understanding of oculomotor neuroanatomy and, second, similar findings can occur with other causes. Because denervated extraocular muscles atrophy, we used high-resolution magnetic resonance imaging (MRI) to assess inferior oblique muscle size in patients with clinically suspected inferior oblique muscle palsy.

Methods: A diagnosis of inferior oblique muscle palsy in 6 patients (4 unilateral, 2 bilateral) was made clinically.

Surgical treatment of strabismus secondary to glaucoma drainage device.

Objective: To describe surgical strategies in a series of patients with diplopia following implantation of a glaucoma drainage device.

Methods: Retrospective review of 9 consecutive patients who underwent strabismus surgery because of strabismus and diplopia after implantation of a glaucoma drainage device.

Results: Seven patients with marked limitation to ocular rotations and incomitant strabismus underwent surgery on the eye with the implant.

Changes in binocular alignment after surgery for concomitant and pattern intermittent exotropia.

Introduction: Although early post-surgical over-correction for intermittent exotropia is widely advised, post-operative drift has not been well quantified in concomitant intermittent exotropia, and has not been described specifically with A and V patterns. While such patterns have been proposed to result from abnormal locations of the rectus muscle pulleys, others have suggested that A and V patterns may result from the disruption of fusion arising from exotropia itself.

Methods: We prospectively performed Hess screen analysis in 20 exotropic patients (mean age 42 +/- 16 yrs) before and two to six times after strabismus surgery, with a post-operative follow-up of 2-108 weeks.

Superior oblique anterior tenectomy.

Purpose: To describe a surgical approach to selectively weaken the anterior cyclotorsional fibers of the superior oblique muscle in subjects with incyclotorsion.

Methods: Retrospective review of five consecutive subjects with diplopia and incyclotorsion who underwent unilateral tenectomy of the anterior fibers of the superior oblique alone or in combination with surgery on another horizontal or vertical rectus muscle.

Results: The mean preoperative incyclotorsion was 7.

Incomitant esotropia following pterygium excision surgery.

Objective: To report the clinical characteristics and treatment of subjects with incomitant esotropia following unilateral pterygium excision.

Methods: A retrospective review of 6 consecutive patients who developed incomitant esotropia, limited abduction, and diplopia following unilateral pterygium excision surgery.

Results: The mean preoperative deviation was 6 prism diopters (PD) (range, 0-25 PD) in the primary position and 13.

Inferior oblique muscle fixation to the orbital wall: a profound weakening procedure.

Introduction: Recurrent or persistent inferior oblique overaction may occur after inferior oblique (IO) recession or anterior transposition. IO nasal and temporal myectomy and anterior-nasal transposition may result in undesirable IO palsy, exotropia, incyclotorsion, or limitation of elevation. Previous studies have shown that a rectus extraocular muscle may be profoundly weakened if the muscle insertion is reattached to adjacent orbital periosteum.

Superior oblique muscle paresis and restriction secondary to orbital mucocele.

Mucoceles are chronic cystic lesions of the paranasal sinuses lined by respiratory epithelium. Their extension into the adjacent orbit may result in proptosis, ocular motility disorders, and diplopia. Brown syndrome secondary to extension of a mucocele into the orbit has been reported previously.

High-resolution magnetic resonance imaging demonstrates varied anatomic abnormalities in Brown syndrome.

Introduction: Although Brown syndrome classically is considered to be limited to the SO tendon sheath and trochlea, it does not always respond to SO surgery. We investigated mechanisms of Brown syndrome by magnetic resonance imaging (MRI).

Methods: Three patients with congenital and 8 with acquired Brown syndrome were compared with matched normal subjects under a prospective protocol of high-resolution, multipositional orbital MRI using surface coils.

Vertical rectus muscle transposition for bilateral Duane syndrome.

Background: Augmented transposition of the superior and inferior rectus muscles to the lateral rectus muscle is effective surgical treatment for esotropia in unilateral Duane syndrome. Medial rectus muscle recession in bilateral Duane syndrome may increase the risk of consecutive exotropia and cause limitation to adduction postoperatively. Vertical rectus muscle transposition may be useful in bilateral Duane syndrome with esotropia.

Extraocular muscle damage associated with endoscopic sinus surgery: an ophthalmology perspective.

Background: Orbital complications associated with endoscopic sinus surgery are well documented. Damage to the medial rectus muscle results in complicated strabismus and disturbing diplopia. The aim of this study was to characterize the types of extraocular muscle injury and the number of muscles involved that may complicate endoscopic sinus surgery and correlate its occurrence to factors in the surgical procedure itself.

Isolated superior oblique tucking: an effective procedure for superior oblique palsy with profound superior oblique underaction.

Purpose: To compare efficacy and complications of isolated unilateral superior oblique tucking in patients with unilateral superior oblique palsy (SOP).

Method: A retrospective analysis of 24 cases of unilateral SOP, 13 Acquired (group 1), and 11 Congenital (group 2), who underwent isolated unilateral superior oblique tuck over a 13-year period was performed.

Results: The mean preoperative vertical deviation in primary gaze was 10 +/- 3 PD for group 1 and 12 +/- 5 PD for group 2 and mean vertical deviation in lateral gaze of affected superior oblique was 19 +/- 5 PD for group 1 and 21 +/- 9 PD for group 2.

Superior oblique muscle involvement in thyroid ophthalmopathy.

Background: Rectus muscle involvement in thyroid ophthalmopathy is well documented. The inferior rectus is the most frequently involved, followed by the medial, superior, and infrequently the lateral rectus. This study reports involvement of the superior oblique muscle as a contributory cause of restrictive strabismus in patients with thyroid ophthalmopathy.

Combined adjustable rectus muscle resection--recession for incomitant strabismus.

Introduction: We sought to report the results of combined adjustable suture resection and recession of a rectus extraocular muscle in a subset of patients who are asymptomatic in the primary position but diplopic in secondary functional gaze positions.

Methods: We undertook a retrospective chart review of 12 patients who underwent a surgical procedure consisting of combined resection and recession of the same rectus extraocular muscle on adjustable suture, the amount of recession being double the amount of resection.

Results: The amount of incomitance reduced from a preoperative mean of 11.

Lateral rectus resections in divergence palsy: results of long-term follow-up.

Introduction: Lateral rectus resections have been previously advocated as surgical options to treat patients with divergence palsy who do not respond well to prisms. This study was undertaken to review the results and long-term follow-up of patients with divergence palsy who underwent lateral rectus resections at our institution.

Methods: Retrospective review of 29 patients (age 35-83 years) with divergence palsy.

Severe strabismus after scleral buckling: multiple mechanisms revealed by high-resolution magnetic resonance imaging.

Purpose: Strabismus occurring after scleral buckling for retinal detachment typically is attributed to scarring, but this is not the only mechanism. We investigated use of magnetic resonance imaging (MRI) to identify a spectrum of mechanisms of strabismus occurring after scleral buckling.

Design: Prospective, noncomparative, observational case series in an academic referral setting.

Strabismic complications following endoscopic sinus surgery: diagnosis and surgical management.

Introduction: Endoscopic surgical techniques improve the surgeon's view of sinus structures but are subject to extraocular muscle complications that cause permanent diplopia.

Methods: A series of 15 patients with strabismus following endoscopic sinus surgery was reviewed retrospectively to characterize the type of muscle injury and report the results of surgical correction.

Results: A variety of insults to the medial rectus (MR) muscle occurred, ranging from contusion, hematoma, oculomotor nerve damage with paralysis, muscle transection, and muscle destruction.