Quantitative eye movement recordings in a patient with acquired bilateral superior oblique palsy before and after a bilateral Harada-Ito procedure

Surgical effects of nasal transposition of inferior rectus muscle - 135 cases of acquired superior oblique palsy

Nasal transposition of the inferior rectus (IR) muscle, which is transposed nasally with the insertion parallel to the spiral of Tillaux, could correct excyclotropia. However, as far as we are aware, there have been no reports examining the surgical effects of this procedure in multiple cases. Therefore, we examined the surgical effects of IR nasal transposition in 135 cases with acquired trochlear nerve palsy at Hyogo College of Medicine Hospital, Nishinomiya, Japan. One muscle width of IR nasal transposition corrected an average 5.6° in excyclotorsion, while bilateral IR nasal transposition corrected average 10.9°. This result shows this procedure is accurate quantitatively. Moreover, IR nasal transposition in combination with IR recession or resection can correct vertical deviation and excyclotorsion simultaneously. The results of this study suggest that IR nasal transposition should become first-line treatment for acquired superior oblique palsy.

Recent developments in the field of superior oblique palsies

PURPOSE OF REVIEW

The superior oblique muscle is a complex structure that evidences considerable variation in its anatomy as well as its rotational effects upon the eye. Our understanding and treatment of patients with superior oblique dysfunction are complicated by our incomplete, though developing, understanding of the sensory and motor adaptations to these dysfunctions. We review articles published over the previous year, which further our understanding of these issues.

RECENT FINDINGS

A thought-provoking three-part series, using monkeys this past year, may provide some insights into time-dependent changes after superior oblique palsy as well as stimulate some interesting conjecture about what, if any, role proprioception may have in strabismus patients. There are some studies, which further our understanding of the torsional effects in superior oblique palsy, the fusional capabilities of normal and palsied patients, and the changes that our surgeries create in the torsional state of the eye. Another case of an ocular torticollis associated with plagiocephaly is presented this year. This past year also saw continuing attempts to determine the best methods for surgically correcting a superior oblique palsy.

SUMMARY

Superior oblique muscle dysfunction continues to stimulate research into its complex and varied clinical manifestations.