| Objective:To evaluate the effectiveness of surgical approaches, especially for fovea-to-disc angle (FDA). Observe the maximum cross-sectional areas for congenital superior oblique palsy (CSOP) to evaluate the superior oblique (SO) size and probe reasons.Methods:39patients (51eyes) were enrolled in Tianjin Eye Hospital from February2012to December2012, including27patients of UCSOP and12patients of BCSOP. Observe and analyze the correction of vertical deviation, torticollis and FDA;17healthy volunteers formed normal control group for FDA.26patients (34eyes) who did CT scan formed patient group, including12patients with UCSOP and8patients with BCSOP;17healthy volunteers formed normal control group. Fundus photographys were taken and FDA was measured with CorelDraw12.0picture software. CT scan was performed to obtain the coronal datas of the maximum cross-sectional areas of SO for those people. Compare the ratios of maximum cross-sectional areas of CSOP patients with healthy volunteers. The paretic side/non-paretic side ratios of the cross-sectional areas in UCSOP and normal control were calculated respectively and compared. Use SPSS software package to do the statistical analysis.Results:1.22patients were cured and5patients turned better in27patients of UCSOP;10patients were cured and1patient turned better in12patients of BCSOP, another1patient was masked BCSOP and was cured in second times;32patients had torticollis preoperatively,25patients’disappeared and1patient’s turned better;30patients’ Bielschowsky signs were positive preoperatively,18patients’were negative and12patients’were still positive, but better.2. In UCSOP,13patients(48.15%) showed exocyclotropia in paretic eyes,4patients (14.81%) on paretic eyes and10patients (37.04%) in both eyes. Preoperatively, the FDA of paretic eyes of UCSOP was (12.23±6.44)°, non-paretic eyes’FDA was (11.94±5.08)°, The FDA of BCSOP was (19.10±8.19)°, it was (6.57±2.70)°in normal control group.FDA was no difference between paretic eyes and non-paretic eyes in UCSOP (P<0.05).The FDA of paretic eyes and non-paretic eyes were smaller than BCSOP (P<0.05), the FDA of SOP was higher than the normal mean (P<0.05).3. Postoperatively, the FDA of paretic eyes, non-paretic eye’s and BCSOP group was(7.15±5.06)°,(8.66±6.90)°and (9.34±5.78)°,and was (6.57±2.70)°in normal control group, there was no statistical difference when compared in pairs (P>0.05). There was statistical difference when compared preoperative FDA with postoperative FDA for the four groups.4. The maximum cross-sectional areas of normal control group were (9.98±1.08)mm2, the maximum cross-sectional areas of paretic eyes and non-paretic eyes in UCSOP were (6.05±3.29) mm2and (10.52±1.61)mm2,the former was smaller than the later two (P<0.05).The areas of BCSOP were (8.67±2.08) mm2, smaller than the normal control group (P<0.05)5. The ratios of maximum cross-sectional areas between two eyes in normal group: OD/OS was1.00±0.08and OS/OD were0.99±0.08, it’s95%confidence interval were0.97-1.05and0.98-1.03, the mean ratios were1.00±0.08, it’s95%confidence interval were0.98-1.03. The ratios of paretic side/non-paretic side of UCSOP were0.55±0.26, the muscles of paretic side was50%of non-paretic side; it’s95%confidence interval were0.43～0.70, was lower than the normal group.Conclusions:1. Surgical approaches were effective ways for congenital superior oblique palsy.2. UCSOP and BCSOP showed exocyclotropia in fundus, and BCSOP was larger than UCSOP; the exocyclotropia of paretic side and non-paretic side of UCSOP was not different, surgical approaches were effective.3. The size of SOP was shrunk on CT and the size of superior oblique of paretic side were smaller than non-paretic side in UCSOP, about50%of non-paretic side. |
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