| Objective:To evaluate the effectiveness of different surgical approaches for congenital superior oblique paralysis patients and investigate the indications of different surgeries for congenital superior oblique paralysis patients.Methods:189patients (232eyes) with superior oblique palsy enrolled from May2007to June2011were treated with seven different surgical procedures on the basis of their preoperative examinations in our hospital. Group A were given disinsertion of the inferior oblique muscle; Group B were given inferior oblique myectomy; Group C were given inferior oblique recession; Group D were given disinsertion of the inferior oblique muscle on one eye and inferior oblique myectomy on the other eye; Group E were given inferior oblique myectomy on one eye and marginal myotomy of inferior oblique tendon on the other eye; Group F were given contralateral inferior rectus muscle recession and Group G were given other surgical procedures of weakening inferior oblique muscle in combination with rectus muscle.Result:The mean post operative follow-up was2-24months.6cases of group A for disinsertion of the inferior oblique muscle, the head tilts of4(66.67%) cases in grop A were eliminated, of the rest2(33.33%) cases turned better; the eye positons of5(83.33%) cases in the front view were straight in this group, and of the rest one(16.67%) turned better; the Bielschowsky signs of6(100%) cases were negative; in group A;5(83.33%) of6cases were cured and the rest one (16.67%) was improved; the average vertical strabismus correction is9.01±4.13Δ.142cases of group B for inferior oblique myectomy, the head tilts of130(91.55%) cases in grop B were eliminated, of the rest12(8.45%) cases turned better; the eye positons of124(87.32%) cases in the front view were straight in this group, and of the rest18(12.68%) cases turned better; the Bielschowsky signs of142(100%) cases were negative; in group B131(92.25%) of142cases were cured and the rest11(7.75%) cases was improved; the average vertical strabismus correction is12.75±4.98Δ.3cases of Group C for inferior oblique recession, the head tilts of2(66.67%) cases in group C were eliminated, of the rest one (33.33%) turned better; the eye positons of2(66.67%) cases in the front view were straight in this group, and of the rest one (33.33%) turned better; the Bielschowsky signs of3(100%) cases were negative; in group C2(66.67%) of3cases were cured and the rest one (33.33%) was improved; the average vertical strabismus correction is13.15±5.06Δ.15cases of group D for disinsertion of the inferior oblique muscle on one eye and inferior oblique myectomy on the other eye, the head tilts of13(86.67%) cases in group D were eliminated, of the rest2(13.33%) cases turned better; the eye positons of12(80.00%) cases in the front view were straight in this group, and of the rest3(20.00%) cases turned better; the Bielschowsky signs of15(100%) cases were negative; in group D13(86.67%) of15cases were cured and the rest2(13.33%) cases were improved.5cases of group E for inferior oblique myectomy on one eye and marginal myotomy of inferior oblique tendon on the other eye, the head tilts of4(80.00%) cases in group E were eliminated, of the rest one(20.00%) turned better; the eye positons of4(80.00%) cases in the front view were straight in this group, and of the rest one (20.00%) turned better; the Bielschowsky signs of5(100%) cases were negative; in group E4(80.00%) of5cases were cured and the rest one(20.00%) was improved.8cases of group F for contralateral inferior rectus muscle recession, the head tilts of7(87.50%) cases in group F were eliminated, of the rest one (12.50%) turned better; the eye positons of6(75.00%) cases in the front view were straight in this group, and of the rest2(25.00%) cases turned better; the Bielschowsky signs of8(100%) cases were negative; in group F7(87.50%) of8cases were cured and the rest one(12.50%) was improved.10cases of group G for other surgical procedures of weakening inferior oblique muscle in combination with rectus muscle, the head tilts of8(80.00%) cases in group G were eliminated, of the rest2(20.00%) cases turned better; the eye positons of7(70.00%) cases in the front view were straight in this group, and of the rest3(30.00%) cases turned better; the Bielschowsky signs of10(100%) cases were negative; in group G8(80.00%) of10cases were cured and the rest2(20.00%) cases were improved. In the whole, cured for168(88.88%) cases, improved in21(11.12%) cases. The total effective rate was100%. Conclusion:The surgery effects of congenital superior oblique paralysis patients are definite. The principle for surgical approaches is to weaken direct antagonist muscle and/or yoke muscle, to augment the paralytic muscle. Different surgical approaches based on the preoperative examinations can obtain higher recovery rates and reduce the risk of second or more operation. |
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