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 - 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 -