Inferior oblique overaction in trochlear nerve palsy: anterior transposition versus myectomy. 2021

Keya Jafari, and Natalie Gibbings, and Saurabh Jain
University College London Medical School, United Kingdom; Royal Free Hospital London, United Kingdom; Luton & Dunstable Hospital, United Kingdom. Electronic address: Keya.jafari.13@ucl.ac.uk.

To compare the effectiveness of inferior oblique myectomy and anterior transposition for correction of hypertropia in trochlear nerve palsy. This retrospective study compares the surgical outcome of 40 patients with hypertropia secondary to trochlear nerve palsy who underwent either a unilateral myectomy or anterior transposition of the inferior oblique muscle. The primary outcome measure was the change in vertical deviation in primary gaze. A total of 40 patients with a mean age of 41 years were included. There was no statistically significant difference between groups (near preoperative hypertropia, P = 0.134 [Mann-Whitney test]). Of these, 19 underwent anterior transpositions and 21 myectomies. Both surgical techniques were successful at reducing levels of vertical deviation (anterior transposition, 89%; myectomy, 76%). However, the relative percentage reduction showed a statistically significant difference in postoperative outcomes, with anteriorization being more effective (anteriorization, 82%; myectomy 48%; P = 0.003). In this study cohort, anterior transposition was more effective than myectomy at correcting vertical deviation in patients with inferior oblique overaction secondary to trochlear nerve palsy.

UI MeSH Term Description Entries
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D009801 Oculomotor Muscles The muscles that move the eye. Included in this group are the medial rectus, lateral rectus, superior rectus, inferior rectus, inferior oblique, superior oblique, musculus orbitalis, and levator palpebrae superioris. Extraocular Muscles,Extraocular Rectus Muscles,Inferior Oblique Extraocular Muscle,Inferior Oblique Muscles,Levator Palpebrae Superioris,Musculus Orbitalis,Oblique Extraocular Muscles,Oblique Muscle, Inferior,Oblique Muscle, Superior,Oblique Muscles, Extraocular,Rectus Muscles, Extraocular,Superior Oblique Extraocular Muscle,Superior Oblique Muscle,Extraocular Muscle,Extraocular Muscle, Oblique,Extraocular Muscles, Oblique,Extraocular Oblique Muscle,Extraocular Oblique Muscles,Extraocular Rectus Muscle,Inferior Oblique Muscle,Muscle, Oculomotor,Muscles, Oculomotor,Oblique Extraocular Muscle,Oblique Muscle, Extraocular,Oblique Muscles, Inferior,Oblique Muscles, Superior,Oculomotor Muscle,Rectus Muscle, Extraocular,Superior Oblique Muscles
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D013285 Strabismus Misalignment of the visual axes of the eyes. In comitant strabismus the degree of ocular misalignment does not vary with the direction of gaze. In noncomitant strabismus the degree of misalignment varies depending on direction of gaze or which eye is fixating on the target. (Miller, Walsh & Hoyt's Clinical Neuro-Ophthalmology, 4th ed, p641) Concomitant Strabismus,Dissociated Horizontal Deviation,Dissociated Vertical Deviation,Heterophoria,Heterotropias,Hypertropia,Non-Concomitant Strabismus,Nonconcomitant Strabismus,Phorias,Squint,Strabismus, Comitant,Strabismus, Noncomitant,Convergent Comitant Strabismus,Mechanical Strabismus,Comitant Strabismus,Comitant Strabismus, Convergent,Deviation, Dissociated Horizontal,Dissociated Horizontal Deviations,Dissociated Vertical Deviations,Heterophorias,Heterotropia,Horizontal Deviation, Dissociated,Hypertropias,Non Concomitant Strabismus,Noncomitant Strabismus,Phoria,Strabismus, Concomitant,Strabismus, Convergent Comitant,Strabismus, Mechanical,Strabismus, Non-Concomitant,Strabismus, Nonconcomitant
D013508 Ophthalmologic Surgical Procedures Surgery performed on the eye or any of its parts. Ophthalmologic Surgical Procedure,Ophthalmological Surgical Procedures,Procedure, Ophthalmologic Surgical,Procedures, Ophthalmologic Surgical,Surgical Procedure, Ophthalmologic,Surgical Procedures, Ophthalmologic,Ophthalmological Surgical Procedure,Procedure, Ophthalmological Surgical,Procedures, Ophthalmological Surgical,Surgical Procedure, Ophthalmological,Surgical Procedures, Ophthalmological
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D020432 Trochlear Nerve Diseases Diseases of the fourth cranial (trochlear) nerve or its nucleus in the midbrain. The nerve crosses as it exits the midbrain dorsally and may be injured along its course through the intracranial space, cavernous sinus, superior orbital fissure, or orbit. Clinical manifestations include weakness of the superior oblique muscle which causes vertical DIPLOPIA that is maximal when the affected eye is adducted and directed inferiorly. Head tilt may be seen as a compensatory mechanism for diplopia and rotation of the visual axis. Common etiologies include CRANIOCEREBRAL TRAUMA and INFRATENTORIAL NEOPLASMS. Cranial Nerve IV Diseases,Fourth Cranial Nerve Diseases,Fourth Cranial Nerve Palsy,Fourth Nerve Palsy,Neurogenic Superior Oblique Palsy,Superior Oblique Myokymia,Superior Oblique Palsy, Neurogenic,Trochlear Nerve Disorders,Trochlear Nerve Palsy,Trochlear Neuropathy,Fourth Nerve Palsies,Myokymia, Superior Oblique,Myokymias, Superior Oblique,Neuropathies, Trochlear,Neuropathy, Trochlear,Palsies, Fourth Nerve,Palsies, Trochlear Nerve,Palsy, Fourth Nerve,Palsy, Trochlear Nerve,Superior Oblique Myokymias,Trochlear Nerve Disease,Trochlear Nerve Disorder,Trochlear Nerve Palsies,Trochlear Neuropathies

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