Evaluation of three superior oblique surgical weakening procedures for A-pattern strabismus

Yu, Jun; Cen, Jie; Zhao, Peiquan; Kang, Xiaoli

doi:10.5935/0004-2749.20190079

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ORIGINAL ARTICLE • Arq. Bras. Oftalmol. 82 (5) • Sep-Oct 2019 • https://doi.org/10.5935/0004-2749.20190079 copy

Evaluation of three superior oblique surgical weakening procedures for A-pattern strabismus

Avaliação de três tipos de cirurgia de enfraquecimento dos músculos superiores oblíquos no estrabismo com padrão em A

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

To evaluate three superior oblique surgical weakening procedures for correcting A-pattern strabismus: tenectomy, superior oblique hang-back recession, and that involving the use of superior oblique suture spacers.

Methods:

The inclusion criteria were A-pattern strabismus ≥10^Δ and horizontal deviation ≥10^Δ, with no other ocular abnormality and a follow-up period of ≥6 months. The 24 patients (mean age, 16.3 ± 8.1 years; mean postoperative follow-up, 9.63 ± 3.11 months) were randomly divided into three groups of 8 patients each. Sigmascan^® Pro 5.0 software was used to measure the degree of torsion pre- and postoperatively.

Results:

Preoperatively, the mean angles of A-pattern deviation were 19.33^Δ° ± 3.53^Δ° (tenectomy group), 15.71^Δ° ± 1.11^Δ° (hang-back recession group), and 14.62^Δ° ± 1.18^Δ° (suture spacers group); these values did not differ significantly. At the final follow-up examination, the mean angles of A-pattern deviation were 4.67^Δ° ± 0.67^Δ° (tenectomy group), 6.29^Δ° ± 1.48^Δ° (hang-back recession group), and 4.38^Δ° ± 1.03^Δ° (suture spacers group), with no statistically significant difference in the correction in A-pattern strabismus among the three groups. Preoperatively, the mean torsional angles were +5.4° ± 3.9° (tenectomy group), +5.6° ± 4.9° (hang-back recession group), and +6.0° ± 3.3° (suture spacers group); these values did not differ significantly. At the final follow-up examination, the mean torsional angles were + 0.3° ± 5.6° (tenectomy group), +0.5° ± 4.6° (hang-back recession group), and +0.2° ± 5.2° (suture spacers group), with no statistically significant difference in the intorsion correction among the three groups.

Conclusion:

All three superior oblique weakening procedures were effective for correcting A-pattern strabismus and fundus intorsion.

Keywords:
Strabismus/surgery; Oculomotor muscles/physiopathology; Ophthalmologic surgical procedures/methods

	Preoperative examination			Final follow-up examination
Patient	Mean angle of A-pattern deviation	Mean torsional angle	Mean angle of horizontal deviation	Mean angle of A-pattern deviation	Mean torsional angle	Mean angle of horizontal deviation
1	22.33	2.4	-20	4.90	2.1	-10
2	17.43	12.1	-18	4.77	-5.2	-8
3	24.71	3.5	18	5.91	8.3	8
4	22.31	11.1	20	4.26	3.2	10
5	18.61	4.3	-20	4.18	1.3	8
6	13.94	4.1	-16	3.66	5.2	-4
7	16.71	2.1	20	4.77	-4.1	8
8	18.61	3.8	-25	4.94	-8.2	-8
Mean	19.33125	5.425	-5.13	4.67375	0.325	0.5
SD	3.533272209	3.897526688	20.42	0.666717706	5.638072	8.73
Mean ± SD	19.33 ± 3.53	5.4 ± 3.9	-5.13 ± 20.42	4.67 ± 0.67	0.3 ± 5.6	0.5 ± 8.73

	Preoperative examination			Final follow-up examination
Patient	Mean angle of A-pattern deviation	Mean torsional angle	Mean angle of horizontal deviation	Mean angle of A-pattern deviation	Mean torsional angle	Mean angle of horizontal deviation
1	17.28	2.8	25	4.61	3	6
2	16.52	16.3	20	7.77	-5.1	6
3	15.36	2.4	-18	5.81	6.3	-4
4	13.80	9.6	-25	6.29	3.5	-4
5	14.66	2.5	25	9.11	1.3	2
6	15.57	4.2	-20	5.42	4.1	4
7	16.21	3.8	-20	6.14	-3.5	-4
8	16.29	3.4	25	5.14	-5.5	4
Mean	15.71125	5.625	1.50	6.28625	0.5125	1.25
SD	1.108415052	4.902113247	23.92	1.478289915	4.564595898	4.53
Mean ± SD	15.71 ± 1.11	5.6 ± 4.9	1.50 ± 23.92	6.29 ± 1.48	0.50 ± 4.6	1.25 ± 4.53

	Preoperative examination			Final follow-up examination
Patient	Mean angle of A-pattern deviation	Mean torsional angle	Mean angle of horizontal deviation	Mean angle of A-pattern deviation	Mean torsional angle	Mean angle of horizontal deviation
1	15.53	5.4	-25	4.31	2.5	-4
2	15.35	12.6	-20	4.32	-4.2	4
3	13.42	2.4	-18	5.22	-8.3	2
4	14.61	3.8	20	6.02	3.2	6
5	13.81	3.6	-16	5.20	1.3	8
6	13.06	6.5	20	3.35	7.7	-4
7	14.61	5.1	-25	3.25	3.2	-8
8	16.60	8.9	-20	3.40	-3.7	-10
Mean	14.62375	6.0375	-10.50	4.38375	0.2125	-0.75
SD	1.183891133	3.315305416	19.08	1.026379733	5.176440448	6.67
Mean ± SD	14.62 ± 1.18	6.0 ± 3.3	-10.50 ± 19.08	4.38 ± 1.03	0.2 ± 5.2	-0.75 ± 6.67

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[1] Corresponding author: Xiaoli Kang/Peiquan Zhao. Department of Ophthalmology. Xinhua Hospital - Shanghai Jiao Tong University School of Medicine - NO 1669, Road Kongjiang, District Yangpu, Shanghai - China. 200092. - E-mail: kangxiaoli2013@126.com; kangxiaoli@xinhuamed.com.cn; zhaopeiquan@xinhuamed.com.cn