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
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  standard. Degree of inferior oblique hyperfunction by Parks  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
. 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
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.
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 . 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 . 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  that the effect of inferior
oblique muscle surgery may be comparable to and after the resettlement operation. Gong Shuxian, etc.  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  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  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  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.
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