TY - JOUR
T1 - One- Versus Two-Muscle Surgery for Presumed Unilateral Fourth Nerve Palsy Associated With Moderate Angle Hyperdeviations
AU - Nash, David L.
AU - Hatt, Sarah R.
AU - Leske, David A.
AU - May, Laura
AU - Bothun, Erick D.
AU - Mohney, Brian G.
AU - Brodsky, Michael C.
AU - Holmes, Jonathan M.
N1 - Funding Information:
Funding/Support: Supported by National Institutes of Health Grant EY024333 (J.M.H.), Research to Prevent Blindness, New York, New York (unrestricted grant to the Department of Ophthalmology, Mayo Clinic), and Mayo Foundation, Rochester, Minnesota. Financial Disclosures: The following authors have no financial disclosures: David L. Nash, Sarah R. Hatt, David A. Leske, Laura May, Erick D. Bothun, Brian G. Mohney, Michael C. Brodsky, and Jonathan M. Holmes. All authors attest that they meet the current ICMJE criteria for authorship.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/10
Y1 - 2017/10
N2 - Purpose To compare 1-muscle vs 2-muscle surgery for moderate-angle hyperdeviations owing to presumed unilateral fourth nerve palsy. Design Retrospective chart review. Methods Seventy-three patients (aged 5–86 years) underwent either 1- or 2-muscle surgery at our institution for moderate hyperdeviation owing to presumed unilateral fourth nerve palsy, measuring 14–25 prism diopters (PD) in straight-ahead gaze at distance fixation. Six-week and 1-year motor success was defined as zero vertical deviation or 1–4 PD undercorrection at distance, overcorrection as any reversal of hypertropia, and undercorrection as >4 PD. Diplopia success was defined as no diplopia, or only rarely for distance straight ahead and reading. Results Twenty-eight patients underwent 1-muscle surgery, and 45 patients underwent 2-muscle surgery. Motor success was similar (64% vs 67%, P >.99 at 6 weeks; 47% vs 55%, P =.8 at 1 year, n = 46), but there were more undercorrections at 6 weeks with 1-muscle surgery (36% vs 16%, P =.09) and more overcorrections at 6 weeks with 2-muscle surgery (0% vs 18%, P =.02). Diplopia success was also somewhat similar between 1- and 2-muscle surgery at 6 weeks (73% vs 60%, P =.5) and 1 year (45% vs 59%, P =.5). Conclusion For moderate-angle hyperdeviations owing to presumed unilateral fourth nerve palsy, there appears no clear advantage of 2-muscle surgery for motor outcomes. Diplopia success was similar between 1- and 2-muscle surgery, owing to a greater number of less symptomatic undercorrections with 1-muscle surgery and a smaller number of more symptomatic overcorrections with 2-muscle surgery.
AB - Purpose To compare 1-muscle vs 2-muscle surgery for moderate-angle hyperdeviations owing to presumed unilateral fourth nerve palsy. Design Retrospective chart review. Methods Seventy-three patients (aged 5–86 years) underwent either 1- or 2-muscle surgery at our institution for moderate hyperdeviation owing to presumed unilateral fourth nerve palsy, measuring 14–25 prism diopters (PD) in straight-ahead gaze at distance fixation. Six-week and 1-year motor success was defined as zero vertical deviation or 1–4 PD undercorrection at distance, overcorrection as any reversal of hypertropia, and undercorrection as >4 PD. Diplopia success was defined as no diplopia, or only rarely for distance straight ahead and reading. Results Twenty-eight patients underwent 1-muscle surgery, and 45 patients underwent 2-muscle surgery. Motor success was similar (64% vs 67%, P >.99 at 6 weeks; 47% vs 55%, P =.8 at 1 year, n = 46), but there were more undercorrections at 6 weeks with 1-muscle surgery (36% vs 16%, P =.09) and more overcorrections at 6 weeks with 2-muscle surgery (0% vs 18%, P =.02). Diplopia success was also somewhat similar between 1- and 2-muscle surgery at 6 weeks (73% vs 60%, P =.5) and 1 year (45% vs 59%, P =.5). Conclusion For moderate-angle hyperdeviations owing to presumed unilateral fourth nerve palsy, there appears no clear advantage of 2-muscle surgery for motor outcomes. Diplopia success was similar between 1- and 2-muscle surgery, owing to a greater number of less symptomatic undercorrections with 1-muscle surgery and a smaller number of more symptomatic overcorrections with 2-muscle surgery.
UR - http://www.scopus.com/inward/record.url?scp=85029573007&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85029573007&partnerID=8YFLogxK
U2 - 10.1016/j.ajo.2017.06.030
DO - 10.1016/j.ajo.2017.06.030
M3 - Article
C2 - 28687220
AN - SCOPUS:85029573007
SN - 0002-9394
VL - 182
SP - 1
EP - 7
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
ER -