Lee Ju-Yeun, Kim Hyo Jeong, Park Kyung-Ah, Oh Shin Yeop, Oh Sei Yeul
Department of Ophthalmology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, #81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Department of Ophthalmology, Samsung Chanwon hospital, Sungkyunkwan University School of Medicine, Chanwon, South Korea.
BMC Ophthalmol. 2018 Dec 17;18(1):325. doi: 10.1186/s12886-018-0977-x.
To compare clinical characteristics according to the laterality of objective ocular torsion in patients with unilateral superior oblique palsy (SOP).
This retrospective study included all patients with a diagnosis of unilateral SOP. They were classified into subgroups according to correspondence between the paretic eye and the extorted eye using fundus photography. Ocular alignment and muscle action were tested by the prism and alternate cover tests and 4-scale movement measure. Various clinical factors, including the amount of preoperative ocular torsion and change in ocular torsion postoperative, were compared between the accordance and disaccordance groups.
A total of 70 Asian patients (140 eyes) were included and underwent fundus photography preoperatively. Excyclotorsion in the paretic eye was defined as accordance (45 patients), excyclotorsion in the nonparetic eye was defined as disaccordance (25 patients). The presence of horizontal strabismus was detected in 28 (62%) patients in the accordance group and only 8 (32%) patients in the disaccordance group (p = 0.024). All horizontal strabismus observed in the accordance group involved exodeviation. The proportion of horizontal strabismus surgery was also significantly larger in the accordance group than the disaccordance group (p = 0.039). Among those patients, there were 26 who underwent fundus photography postoperatively. There was significant reduction in ocular excyclotorsion postoperatively in the accordance group (p = 0.001), but no significant reduction postoperatively in the disaccordance group (p = 0.270). There was no significant correlation between the amount of torsional reduction and the amount of vertical deviation reduction (p = 0.979).
In cases of preoperative excyclotorsion in paretic eyes, careful consideration of combined horizontal misalignment which may require surgical correction is helpful to manage unilateral SOP.
比较单侧上斜肌麻痹（SOP）患者客观眼扭转的左右侧性的临床特征。
这项回顾性研究纳入了所有诊断为单侧SOP的患者。使用眼底照相术根据麻痹眼与外旋眼的对应关系将他们分为亚组。通过棱镜和交替遮盖试验以及4级运动测量来测试眼位和肌肉功能。比较了符合组和不符合组之间的各种临床因素，包括术前眼扭转量和术后眼扭转的变化。
共纳入70例亚洲患者（140只眼），术前均接受了眼底照相术。麻痹眼的外旋转定义为符合（45例患者），非麻痹眼的外旋转定义为不符合（25例患者）。符合组中28例（62%）患者存在水平斜视，而不符合组中仅8例（32%）患者存在水平斜视（p = 0.024）。符合组中观察到的所有水平斜视均为外斜视。符合组中水平斜视手术的比例也明显高于不符合组（p = 0.039）。在这些患者中，有26例术后接受了眼底照相术。符合组术后眼外旋转明显减少（p = 0.001），而不符合组术后无明显减少（p = 0.270）。扭转减少量与垂直偏差减少量之间无显著相关性（p = 0.979）。
在术前麻痹眼存在外旋转的病例中，仔细考虑可能需要手术矫正的合并水平斜视，有助于处理单侧SOP。
