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Congenital superior oblique palsy Analysis_2777

By Patrick Perry,2014-10-30 14:06
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Congenital superior oblique palsy Analysis_2777

Congenital superior oblique palsy Analysis

     Abstract Objective: To investigate the congenital

    superior oblique palsy treatment. Methods: 39 patients admitted to hospital 2004-10/2005-02 congenital superior

    oblique palsy, according to suffer from eye level of the

    inferior oblique hyperfunction and the vertical gradient of the size of choice after the resettlement inferior oblique, inferior oblique cut and partially removed, before the transposition of inferior oblique muscle, or joint

    contralateral eye superior rectus, inferior rectus muscle surgery. Results: The cure in 28 cases (72%), improved in 10 cases (26%), ineffective in 1 (2%). Conclusion: The congenital superior oblique palsy by weakened muscles and their spouses directly antagonistic muscles, strengthen muscles and paralysis of the principle of an indirect antagonist, in patients with inferior oblique hyperfunction according to the extent and degree of vertical strabismus size of different surgical options available to good results.

     Key words Congenital superior oblique palsy strabismus surgery extraocular muscle

     0 Introduction

     Congenital superior oblique palsy is a paralysis of the most common type of strabismus, monocular more common, and many more compensatory head position in the first

    consultation. Without timely treatment at an early age, will be induced by face, neck, upper chest and spinal deformities. 2004-10/2005-02 now admitted to our hospital 39 cases of surgical treatment of congenital superior oblique palsy cases

    reported as follows.

     An object and method

     1.1 Object Changzhou City Hospital of Integrated Chinese and Western Medicine 2004-10/2005-02 admitted patients with

    congenital superior oblique palsy, 39 patients were male and 23 cases, female 16 cases. Treatment of age 3 to 18 (mean 6.7) years of age; monocular incidence of 36 cases, three cases of eye disease; purely on 9 cases of strabismus, there were 35 cases of compensatory head posture, combined with secondary exotropia 24 cases, 6 cases of esotropia.

     1.2 Method routine examination vision, 10g / L of atropine eye drops after the full paralysis of ciliary muscle retinoscopy, correction of refractive errors, using alternate prism cover and the same as the screened 33cm and 5m when the

    degree of strabismus. Congenital superior oblique palsy

    diagnostic criteria by von Noorden [1] standard. Degree of inferior oblique hyperfunction by Parks [2] of the ranking method. Preoperative vertical gradient of 10 ~ 80Δ, the

    median 20Δ. Features all the options patients have varying

    degrees of inferior oblique hyperfunction, Bielschowsky positive sign. 34 cases of patients with typical compensatory head posture. Degree of vertical strabismus according to the patients and the degree of inferior oblique hyperfunction were divided into four groups: A group of vertical strabismus degree 5Δ below, no obvious function of the inferior oblique hyperfunction who do not have surgery, patients in this group did not choose; B group of vertical strabismus degree 5 ~ 15Δ , inferior oblique hyperfunction 1 ~ 2 persons, a total of 11 cases suffering from immediate superior oblique or inferior oblique cut off after the resettlement, and partial resection; C group of vertical strabismus degrees 15 ~ 25Δ, inferior

    oblique hyperfunction 2 ~ 3 persons, A total of 17 patients

    suffering from the moment oblique lines before the switch operation; D group of vertical strabismus degree ? 25Δ

    persons, inferior oblique hyperfunction 3 ~ 4 persons, a total of 11 patients suffering from the moment oblique lines cut and

    partially removed, while firms of Eye on the lateral rectus muscle shortening or the contralateral superior rectus immediate surgery after the resettlement. While giving the combined level of strabismus correction. Eye Institute of the Chinese national children's use of strabismus amblyopia treatment group developed strabismus efficacy evaluation criteria, according to cure, improved, ineffective evaluation

[3]. Healing: At first glance-bit vertical gradient ? 5Δ,

    compensatory head position disappeared, Bielschowsky sign (-);

    improved: At first glance-bit vertical gradient> 5Δ,

    compensatory head position improved markedly, Bielschowsky sign (-); invalid: At first glance-bit vertical gradient> 10

    Δ, compensatory head position no better, Bielschowsky sign

    ().

     2 Results

     39 patients were followed up 1 ~ 10mo, including: A Group: no surgery, to give to wear prism lenses, or observation; B Group: surgery, cured, 9 cases improved and 2 cases ineffective 0 cases; C Group: surgery, cured 11 cases,

    improved in 6 cases, ineffective 0 cases; D Group: surgery, cured, 8 cases improved and 2 cases ineffective in 1 case. Of which 5 patients suffering from the moment oblique lines cut and partially removed, while the opposite line of the moment after the resettlement rectus surgery in 2 cases cured, 2 cases improved, 1 patient preoperative vertical strabismus 80Δ, postoperative residual 35Δ vertical strabismus degrees,

    null and void; this group of 6 patients suffering from immediate use oblique partial resection, while shorter lines

    contralateral superior rectus eye correction surgery are given. 34 cases of patients with compensatory head position significantly improved or disappeared.

     3 Discussion

     Congenital superior oblique palsy is a congenital

    paralysis of the most common type of strabismus, the incidence rate of approximately 50% of vertical strabismus. Clinical classification of congenital, acquired two kinds, accounting for 39.5% of congenital, trauma accounted for 37.3%, idiopathic 23.2%. Unilateral congenital superior oblique palsy in which accounts for about 70.6%, accounting for 29.4% of bilateral [4]. Compensatory head posture in congenital superior oblique palsy is the most important signs, most of the same time with ipsilateral inferior oblique hyperfunction, showing infestation of eye-eye height, head twisted to the

    healthy side, or combined level of strabismus [5]. Without timely treatment at an early age, will be induced by face, neck, upper chest and spinal deformities.

     Weakened by surgical or spouse direct antagonist muscle, muscle paralysis or indirectly, to strengthen the principle of antagonistic muscle. According to the inferior oblique hyperfunction suffering from eye level and the size of the vertical squint choose resettlement after inferior oblique, inferior oblique cut and partially removed, before the transposition of inferior oblique muscle, or joint contralateral eye superior rectus, inferior rectus muscle surgery. Wen-Tao Zhang et al [6] that the effect of inferior

    oblique muscle surgery may be comparable to and after the resettlement operation. Gong Shuxian, etc. [7] considers that the vertical gradient in the 15 ~ 20Δ in patients with

    inferior oblique muscle before the switch operation than after the resettlement and amputation of the inferior oblique muscle tendon surgery. Mengxiang Cheng [8] that the inferior oblique overaction in turn on a slope when the extent of 5 ~ 8Δ below

    to do under the oblique cut, 10Δ above shall be made after

    partial hepatectomy or a different degree of resettlement operation or switch operation [ 9,10]. Degree of vertical strabismus in patients in this group 5 ~ 15Δ line after the

    resettlement or the inferior oblique resection of the inferior oblique and vertical strabismus degree of 15 ~ 25Δ-line

    switch operation before the inferior oblique muscle surgery were successful. Reposted elsewhere in the paper for free download http://

     For patients with superior oblique palsy in the greater degree of vertical strabismus, Yang Cun [11] think that

    watching eye should diminish its antagonist, or paralysis of the inferior oblique eye; to monitor those suffering from eye muscles weaken his or her spouse, or health now rectus; in turn to reinforce the weakened muscles and muscle under the

    effects of change are the same, it is best not do under the transferred muscle weakening surgery. Superior oblique palsy with paralysis of eyes watching when bound to accept the excessive nerve impulses, according to Hering law, the spouse or health now rectus muscle also received an excessive amount of nerve impulses, as the disease progresses, there will be superior oblique muscle of the directly antagonistic oblique muscles suffering from hyperthyroidism and now the indirect antagonistic superior oblique eye superior rectus muscle of

    incomplete paralysis. Due to anatomical factors, excessive inferior rectus surgery will affect the lower eyelid function, therefore, this group selected six cases of patients suffering

from the moment ? 25Δ oblique partial resection, while

    shorter lines contralateral superior rectus eye correction surgery are given, and surgical Correction is not contrary to the principle.

     Bilateral congenital superior oblique palsy signs of clinical manifestations and more complex than the unilateral.

    Bilateral paralysis of vertical strabismus in primary position compared with unilateral paralysis is usually small, external rotation is greater than 10 ~ 15 ?, clear V sign, bilateral

    Bielschowsky sign (), the performance of compensatory head

    position for the next chin adduction. Clinically divided into 3 types: symmetric, asymmetric type and cryptic. Symmetric feasible symmetric inferior oblique weakening surgery eyes, while the asymmetric type and cover type is often difficult to diagnose before surgery, both eyes simultaneously under asymmetric oblique lines weakened, asymmetrical eyes, to strengthen and rectus superior oblique procedures to correct eye position . When the clinically difficult to distinguish between a single, bilateral, when allowing the first diagnosis and resolution of unilateral paralysis [1] points surgeries. We are one cases of congenital superior oblique palsy patients with high eye-line and partial resection of inferior oblique cut off, after 1wk review orthotopic corneal Yingguang,

    alternate cover basically does not move, eye movement generally normal, compensatory head position disappeared. 3mo after its review of non-surgical eye surgery is higher than

    eye, eye movement non-surgical moment oblique hyperfunction ?

    Egyptian Jun ielschowsky sign: surgery eyes (-), non-surgical

    eye (+), and the emergence of reverse compensatory head posture, confirmed that the patient had bilateral congenital superior oblique palsy hidden type, to be OK now another oblique cut and partially removed. Postoperative follow-up

    3mo, patients with eye position and head position were to be corrected, bilateral Bielschowsky sign (-).

     In short, congenital superior oblique palsy aim is to eliminate vertical deviation and compensatory head position to

    avoid the adult face, neck, upper chest and spinal deformities, the establishment of binocular single vision and the restoration of normal function of eye movement. Congenital superior oblique palsy in patients with early diagnosis and treatment is particularly important, according to degree of hyperthyroidism in patients with inferior oblique and vertical

    strabismus degree of the size of different surgical options available to good results.

     References

     1 Von Noorden GK, Murray E, Wong SY. Superior oblique

    paralysis.a review of 270 cases. Arch opthalmol, 1986; 104 (12) :1771-1776

     2 Wilson ME, Parks MM. Primary inferior oblique overaction in congenital esotropia, accommodative esotropia, and intermittent esotropia. Ophthalmolgy, 1989; 96:950-957

     3 Eye Institute of the Chinese national children's strabismus amblyopia treatment group. Strabismus efficacy evaluation criteria. Chinese Journal of pediatric ophthalmology and strabismus, 1996; 4 (4): 145

     4 HU Cong. The clinical diagnosis of strabismus. Beijing: Science Press, 2001; 4:135-167

     5 Pei Chong-Gang, Fu S, Zhong Xiu-Liang. Comitant strabismus

    with the level of vertical strabismus surgery. International Ophthalmology, 2004; 4 (1): 167

     6 Wen-Tao Zhang, Han Hui-Fang, Gui-yun. Inferior oblique

    amputation oblique palsy treatment efficacy analysis. Practical Ophthalmology, 1993; 11 (7) :421-423

     7 Gongshu Xian, Fei Fei, Liu Xin-Rong. Surgical treatment of

    congenital superior oblique palsy analysis. Chinese Journal of

    pediatric ophthalmology and strabismus, 2003; 11 (4) :179-180

     8 Meng Xiangcheng. Strabismus amblyopia and pediatric ophthalmology. Heilongjiang: Heilongjiang People's Publishing House, 2001; 1:328

     9 Li-Ying Jin, Yang Dongguang. Inferior oblique believers

    after the switch operation for congenital superior oblique palsy. International Ophthalmology, 2006; 6 (1): 240

     10 RB, GAO Xiao-Wei, Luo Ying, Feng, Zhen-Hua Xu. And some of

    the inferior oblique muscle transposition surgery correction

    of large-angle vertical deviation 32 cases. International Ophthalmology, 2005; 5 (4) :696-697

     11 Yang Cun. Extraocular myopathy school. Zhengzhou: Zhengzhou University Press, 2003; 4:354-355 reposted elsewhere

    in the paper for free download http://

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