Surgical Management of Masquerading Superior Oblique Palsy

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-02-21 DOI:10.1016/j.ajo.2025.02.015

Qingyu Meng , Veronika Yehezkeli , Joseph L. Demer

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引用次数: 0

Abstract

Purpose

To compare the surgical outcomes between superior oblique (SO) palsy (SOP) and masquerading SO palsy (mSOP).

Design

Comparative interventional case series.

Methods

Medical records of patients with SOP and mSOP were reviewed from 1991 to 2024. Palsy cases had maximum SO cross section in the hypertropic eye no more than 80% of that in the fellow eye, whereas mSOP cases had bilaterally symmetric SO muscles on magnetic resonance imaging. Types of surgery and effect on hypertropia were compared between groups.

Result

A total of 39 patients aged 38±20 (standard deviation) years had SOP and 18 aged 36±17 years had mSOP. Maximum palsied SO cross section was 10.6±3.8 mm², significantly smaller than 18.9±4.0 mm² of the contralateral fellow (P < .0001), but was bilaterally symmetric in mSOP. Mean preoperative central gaze hypertropia was similar at 14.7±9.8Δ in SOP and 11.0±6.9Δ in mSOP (P = .2). The commonest surgery was ipsilateral inferior oblique (IO) weakening combined with contralateral inferior rectus (IR) recession, followed by ipsilateral IO weakening alone and contralateral IR recession alone. After 41±65 months’ follow-up in SOP and 22±41 months in mSOP, central gaze hypertropia decreased from 14.7±9.8Δ to 1.7±4.1Δ in SOP, and from 11.0±6.9Δ to –2.9±5.4Δ in mSOP (both P < .0001). Surgical effect was similar at 13.2±10.3Δ in SOP and 14.1±10.0Δ in mSOP. Reoperation rate was low and similar in both groups.

Conclusion

Clinical characteristics and surgical effect are similar in mSOP and SOP. Conventional surgeries are comparably effective in both. This suggests that mechanism beyond SO muscle function drive head tilt–dependent cylcovertical strabismus.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.