Técnicas de Harada-Ito y Fells en el tratamiento de la diplopía torsional en paresias del oblicuo superior

Abstract

Background and purpose

To describe the results of isolated Harada-Ito or Fells modification surgery in the treatment of diplopia, torticollis and excyclotorsion secondary to superior oblique paresis (SOP).

Material and methods

Retrospective workup of subjects operated on since 2015-November 2024. The age, sex, etiology of SOP, preoperative and immediate and late postoperative excyclotorsion, pre- and postoperative vertical deviation and torticollis, as well as type of suture (resorbable or not) were collected. The time of evolution of the SOP and follow-up from surgery to data collection were recorded. The resolution or improvement of diplopia, excyclotorsion and torticollis were considered a good outcome.

Results

Eight cases were operated on (4 women). In six, the left eye, bilateral (1). The etiology of the SOP was neoplasia (2), trauma (1), ischemic (3), infectious (1), idiopathic (1). All had subjective excyclotorsion (between 5-15°) that disappeared at the end of follow-up. The mean torsion correction was 7.87 ± 2.47°, with resorbable suture 7 ± 2.44° and non-resorbable 8.75 ± 2.5°. Torticollis was observed before surgery in all 8 patients, which resolved after surgery except in one case. Preoperative vertical deviation ranged from a minimum of 2 pd to a maximum of 8 pd, resolving in seven cases. The preoperative diplopia resolved in 4 of the 8 cases and improved in the rest.

Conclusions

Harada-Ito surgery and Fells modification resolved or improved diplopia, symptomatic excyclotorsion and torticollis in patients diagnosed with SOP. No resorbable suture had a greater effect on extortion correction (not statistically significant) at the end of follow-up.