| Objective To evaluate two superior oblique weakening procedures,tenectomy (ST)and recession (SR),and their effects on correction of A-pattern,superior oblique overaction(SOOA),torsion,binocular vision function and their complications.Methods We reviewed the records of consecutive patients who had superior oblique weakening with ST or SR in Tianjin Eye Hospital from November2011to and January2013.18patients including11with bilateral SOOA and7with unilateral had been treated with ST. Among these18patients,11were diagnosed A exotropia,2were A esotropia,2were Helveston syndrome,2were paralytic strabismus and1were diagnosed Brown syndrome. There were all15patients had A-pattern strabismus in this group,11had been undergone both eyes surgery while4had monocular.20patients including11with bilateral SOOA and9with unilateral had been treated with SR. Among these20patients,5were diagnosed A exotropia,1were A esotropia,10were Helveston syndrome,3were paralytic strabismus and1were diagnosed Brown syndrome. There were all16patients had A-pattern strabismus in this group,11had been undergone both eyes surgery while5had monocular. Pre-and Post-operative superior oblique muscle function, change in A-pattern and downward deviation were examined and studied. Objective cyclotorsion were examined pre-operation,as well as1,30,90days post-operation with fundus photograph. The photographs were transferred to a computer and then the fovea-disa angle (FDA) was measured by a software for drawing pictures.Subjective cyclotorsion were assessed by synoptophore,while the binocular vision function by synoptophore, Bagolini glasses and Titmus before and after surgery.All statistical calculations were done with SPSS17.0software.Results1. The mean A-pattern of11cases with bilateral ST was (27.27±11.77) Δ before operation,and the mean correction was (28.73±15.45) Δ;while the SR group’s mean A-pattern was (37.45±16.07) before operation, and the mean correction was (36.36±13.79) Δ,there was no significant difference in correcting A-pattern between ST and SR (t=-1.38, P>0.05),and there was linear positive relation between the correction of A-pattern and the A-pattern before operation (r>0,P<0.05).The ST group’s mean downward exotropia was (47.55±12.86) Δ before and (0.88±6.78) Δ after operation,mean correction was (47.55±15.11) Δ;while the SR group’s mean downward exotropia was (47.55±12.86) Δ before and (2.55±6.76) Δ after operation,mean correction was (47.36±17.39) Δ, there was also no significant difference in correcting downward deviation between ST and SR (t=0.38, P>0.05),and there was linear positive relation between the correction of downward deviation and the downward deviation before operation (r>0,P<0.05).However, the degree of SOOA was not correlated with the correction of A-pattern(P>0.05)2. To11cases with bilateral ST,the combined FDA of preoperation and1,30,90days after operation were (20.23±6.52)°and (7.56±5.81)°,(6.24±6.55)°,(5.68±6.88)°respectively, while the SR group were (17.74±7.89)°,(7.63±4.28)°,(6.05±6.11)°,(7.33±6.17)°. To7cases with unilateral ST, the combined FDA of preoperation and1,30,90days after operation were (11.93±7.37)°,and (5.13±4.46)°,(3.78±4.03)°,(4.57±5.05)°,while the9cases with unilateral SR were (13.40±6.13)°,(5.06±3.99)°,(3.59±3.47)°,(5.07±3.35)°. The comparision of all patients in objective ocular cyclotorsion showed significant difference pre-and post-operation (P<0.05), and no significant difference after operation(P>0.05). There was no significant difference in correcting intorsion between ST and SR(P>0.05). There was linear positive relation between the correction of intorsion and the intorsion before operation (r>0,P<0.05), and also the degree of SOOA was not correlated with the correction of intorsion(P>0.05).3. Some patients’ binocular vision function of these two group were ameliorated after surgery.The patients’ symptom of abnormal head position were ameliorated effectively after operation. The comparision of complication rate showed no significant difference between ST and SR, however, there was higher complication rate in ST group (16.7%) than in SR group (5%).Conclusion1. Both ST and SR procedures can effectively correct A-pattern with SOOA, ST and SR had no difference in the correction of A-pattern.2. Both ST and SR procedures can effectively correct intorsion with SOOA, ST and SR had no difference in the correction of intorsion, and the surgical effect was reliable. Subjective cyclotorsion was different with objective cyclotorsion before and after operation.3. Both ST and SR procedures can effectively ameliorate patients’ symptom of abnormal head position,Whether SR was better than ST for binocular vision function would need further study.4. SR’s recession position is based on oblique hyperfunction degree and the predictability of surgical effect is well established. |
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