Strabismus · 2025
A nasal approach to a superior oblique tuck in the management of longstanding superior oblique palsy.
СтатьяКлинический случайНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Rees Amelia, Kilduff Caroline, De Smit Elisabeth, Kennedy Alasdair
Аннотация
INTRODUCTION: Superior oblique palsy (SOP) is the most common cyclovertical muscle palsy, often presenting with vertical misalignment, excyclorotation, and abnormal head posture. The superior oblique tuck (SOT) is a widely accepted treatment option, though carries risks such as iatrogenic Brown syndrome. While a temporal approach is conventionally used, this case presents an alternative nasal approach to the SOT in a patient who had already undergone a temporal SOT.
METHODS: A 71-year-old female presented with persistent diplopia and a left head tilt. Examination revealed right hypertropia and excyclorotation in primary gaze, consistent with right SOP. Initial management with inferior oblique disinsertion yielded little improvement, and a subsequent temporal SOT also failed to correct the misalignment. Given persistent symptoms, a revision SOT was performed, using a nasal approach due to extensive scarring temporally.
RESULTS: Six months postoperatively, diplopia improved significantly in primary and downgaze. Vertical deviation in the left eye reduced from 7Δ BD pre-operatively to 1Δ BU in primary position and from 21Δ BD to 4Δ BD in laevodepression and excyclorotation improved. A mild iatrogenic Brown syndrome resulted, though this improved over time.
DISCUSSION/CONCLUSION: In conclusion, this case highlights the nasal SOT as a viable surgical option in the management of SOP where alternative treatment options have been exhausted.
METHODS: A 71-year-old female presented with persistent diplopia and a left head tilt. Examination revealed right hypertropia and excyclorotation in primary gaze, consistent with right SOP. Initial management with inferior oblique disinsertion yielded little improvement, and a subsequent temporal SOT also failed to correct the misalignment. Given persistent symptoms, a revision SOT was performed, using a nasal approach due to extensive scarring temporally.
RESULTS: Six months postoperatively, diplopia improved significantly in primary and downgaze. Vertical deviation in the left eye reduced from 7Δ BD pre-operatively to 1Δ BU in primary position and from 21Δ BD to 4Δ BD in laevodepression and excyclorotation improved. A mild iatrogenic Brown syndrome resulted, though this improved over time.
DISCUSSION/CONCLUSION: In conclusion, this case highlights the nasal SOT as a viable surgical option in the management of SOP where alternative treatment options have been exhausted.