Adjustable Bilateral Superior Oblique Tendon Advancement for Bilateral Fourth Nerve Palsy

Bashar M. Bata, David A. Leske, Jonathan M Holmes

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose Bilateral fourth nerve palsy may be symmetric or asymmetric with combined vertical and excylotropic deviations and so there may be an advantage to independent adjustment of vertical and torsional components. We report a surgical technique that allows such independent adjustment. Design Retrospective interventional case series. Methods Fifteen patients, aged 17–73 years, underwent adjustable bilateral superior oblique tendon advancements for bilateral fourth nerve palsy: 11 symmetric (≤2 prism diopters [pd] hyperdeviation in straight-ahead gaze) and 4 asymmetric. Motor alignment was assessed with double Maddox rods and prism and alternate cover tests preoperatively, pre- and postadjustment, and 6 weeks postoperatively. Results Preoperative torsion ranged from 7 to 30 degrees excyclotropia (mean 17 ± 7 degrees) and hyperdeviation from 0 to 10 pd. Preadjustment torsion ranged from 5 degrees excyclotropia to 40 degrees incyclotropia, and hyperdeviation from 0 to 8 pd. Twelve of the 15 patients (80%) were adjusted to a target of 0 pd hyperphoria and 10 degrees incyclotropia (actual mean 9 degrees incyclotropia, range 2–13 degrees incyclotropia). At 6 weeks postoperatively there was expected excyclodrift (to mean 4 degrees excyclotropia, range 0 degrees incyclotropia to 15 degrees excyclotropia), but 13 (87%) had 5 degrees or less excyclotropia and 14 (93%) had 2 pd or less hyperdeviation. Mean torsional correction from preoperative to preadjustment was 31 ± 14 degrees (P <.0001), and from preoperative to 6 weeks was 13 ± 6 degrees (P <.0001). Conclusions Adjustable bilateral superior oblique tendon advancement allows independent control of torsional and vertical components of the deviation, and therefore may be useful in cases of bilateral superior oblique palsy.

Original languageEnglish (US)
Pages (from-to)115-121
Number of pages7
JournalAmerican Journal of Ophthalmology
Volume178
DOIs
StatePublished - Jun 1 2017

Fingerprint

Trochlear Nerve Diseases
Tendons
Paralysis

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Adjustable Bilateral Superior Oblique Tendon Advancement for Bilateral Fourth Nerve Palsy. / Bata, Bashar M.; Leske, David A.; Holmes, Jonathan M.

In: American Journal of Ophthalmology, Vol. 178, 01.06.2017, p. 115-121.

Research output: Contribution to journalArticle

@article{9357d713443241a2a25956093f17c5ed,
title = "Adjustable Bilateral Superior Oblique Tendon Advancement for Bilateral Fourth Nerve Palsy",
abstract = "Purpose Bilateral fourth nerve palsy may be symmetric or asymmetric with combined vertical and excylotropic deviations and so there may be an advantage to independent adjustment of vertical and torsional components. We report a surgical technique that allows such independent adjustment. Design Retrospective interventional case series. Methods Fifteen patients, aged 17–73 years, underwent adjustable bilateral superior oblique tendon advancements for bilateral fourth nerve palsy: 11 symmetric (≤2 prism diopters [pd] hyperdeviation in straight-ahead gaze) and 4 asymmetric. Motor alignment was assessed with double Maddox rods and prism and alternate cover tests preoperatively, pre- and postadjustment, and 6 weeks postoperatively. Results Preoperative torsion ranged from 7 to 30 degrees excyclotropia (mean 17 ± 7 degrees) and hyperdeviation from 0 to 10 pd. Preadjustment torsion ranged from 5 degrees excyclotropia to 40 degrees incyclotropia, and hyperdeviation from 0 to 8 pd. Twelve of the 15 patients (80{\%}) were adjusted to a target of 0 pd hyperphoria and 10 degrees incyclotropia (actual mean 9 degrees incyclotropia, range 2–13 degrees incyclotropia). At 6 weeks postoperatively there was expected excyclodrift (to mean 4 degrees excyclotropia, range 0 degrees incyclotropia to 15 degrees excyclotropia), but 13 (87{\%}) had 5 degrees or less excyclotropia and 14 (93{\%}) had 2 pd or less hyperdeviation. Mean torsional correction from preoperative to preadjustment was 31 ± 14 degrees (P <.0001), and from preoperative to 6 weeks was 13 ± 6 degrees (P <.0001). Conclusions Adjustable bilateral superior oblique tendon advancement allows independent control of torsional and vertical components of the deviation, and therefore may be useful in cases of bilateral superior oblique palsy.",
author = "Bata, {Bashar M.} and Leske, {David A.} and Holmes, {Jonathan M}",
year = "2017",
month = "6",
day = "1",
doi = "10.1016/j.ajo.2017.03.028",
language = "English (US)",
volume = "178",
pages = "115--121",
journal = "American Journal of Ophthalmology",
issn = "0002-9394",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Adjustable Bilateral Superior Oblique Tendon Advancement for Bilateral Fourth Nerve Palsy

AU - Bata, Bashar M.

AU - Leske, David A.

AU - Holmes, Jonathan M

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Purpose Bilateral fourth nerve palsy may be symmetric or asymmetric with combined vertical and excylotropic deviations and so there may be an advantage to independent adjustment of vertical and torsional components. We report a surgical technique that allows such independent adjustment. Design Retrospective interventional case series. Methods Fifteen patients, aged 17–73 years, underwent adjustable bilateral superior oblique tendon advancements for bilateral fourth nerve palsy: 11 symmetric (≤2 prism diopters [pd] hyperdeviation in straight-ahead gaze) and 4 asymmetric. Motor alignment was assessed with double Maddox rods and prism and alternate cover tests preoperatively, pre- and postadjustment, and 6 weeks postoperatively. Results Preoperative torsion ranged from 7 to 30 degrees excyclotropia (mean 17 ± 7 degrees) and hyperdeviation from 0 to 10 pd. Preadjustment torsion ranged from 5 degrees excyclotropia to 40 degrees incyclotropia, and hyperdeviation from 0 to 8 pd. Twelve of the 15 patients (80%) were adjusted to a target of 0 pd hyperphoria and 10 degrees incyclotropia (actual mean 9 degrees incyclotropia, range 2–13 degrees incyclotropia). At 6 weeks postoperatively there was expected excyclodrift (to mean 4 degrees excyclotropia, range 0 degrees incyclotropia to 15 degrees excyclotropia), but 13 (87%) had 5 degrees or less excyclotropia and 14 (93%) had 2 pd or less hyperdeviation. Mean torsional correction from preoperative to preadjustment was 31 ± 14 degrees (P <.0001), and from preoperative to 6 weeks was 13 ± 6 degrees (P <.0001). Conclusions Adjustable bilateral superior oblique tendon advancement allows independent control of torsional and vertical components of the deviation, and therefore may be useful in cases of bilateral superior oblique palsy.

AB - Purpose Bilateral fourth nerve palsy may be symmetric or asymmetric with combined vertical and excylotropic deviations and so there may be an advantage to independent adjustment of vertical and torsional components. We report a surgical technique that allows such independent adjustment. Design Retrospective interventional case series. Methods Fifteen patients, aged 17–73 years, underwent adjustable bilateral superior oblique tendon advancements for bilateral fourth nerve palsy: 11 symmetric (≤2 prism diopters [pd] hyperdeviation in straight-ahead gaze) and 4 asymmetric. Motor alignment was assessed with double Maddox rods and prism and alternate cover tests preoperatively, pre- and postadjustment, and 6 weeks postoperatively. Results Preoperative torsion ranged from 7 to 30 degrees excyclotropia (mean 17 ± 7 degrees) and hyperdeviation from 0 to 10 pd. Preadjustment torsion ranged from 5 degrees excyclotropia to 40 degrees incyclotropia, and hyperdeviation from 0 to 8 pd. Twelve of the 15 patients (80%) were adjusted to a target of 0 pd hyperphoria and 10 degrees incyclotropia (actual mean 9 degrees incyclotropia, range 2–13 degrees incyclotropia). At 6 weeks postoperatively there was expected excyclodrift (to mean 4 degrees excyclotropia, range 0 degrees incyclotropia to 15 degrees excyclotropia), but 13 (87%) had 5 degrees or less excyclotropia and 14 (93%) had 2 pd or less hyperdeviation. Mean torsional correction from preoperative to preadjustment was 31 ± 14 degrees (P <.0001), and from preoperative to 6 weeks was 13 ± 6 degrees (P <.0001). Conclusions Adjustable bilateral superior oblique tendon advancement allows independent control of torsional and vertical components of the deviation, and therefore may be useful in cases of bilateral superior oblique palsy.

UR - http://www.scopus.com/inward/record.url?scp=85017458184&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017458184&partnerID=8YFLogxK

U2 - 10.1016/j.ajo.2017.03.028

DO - 10.1016/j.ajo.2017.03.028

M3 - Article

C2 - 28366647

AN - SCOPUS:85017458184

VL - 178

SP - 115

EP - 121

JO - American Journal of Ophthalmology

JF - American Journal of Ophthalmology

SN - 0002-9394

ER -