Department of Ophthalmology, Fauji Foundation Hospital, Foundation University Islamabad, Defence Avenue, DHA Phase-I, Islamabad, 44000, Pakistan.
Int Ophthalmol. 2022 Oct;42(10):3165-3181. doi: 10.1007/s10792-022-02316-3. Epub 2022 May 18.
To describe etiology, clinical characteristics, radiological features and management of isolated inferior oblique pareses.
A diagnosis of inferior oblique paresis was made after a thorough strabismus examination and neuroimaging. The patients were managed surgically with adjustable strabismus surgery, or conservatively. Surgical success was defined as average horizontal deviation within ≤ 10 prism diopters [PD] post-operatively and for vertical deviation, it was ≤ 5 PD, at last follow-up.
Seven cases were congenital, 6 cases were bilateral, with esotropia in 6 cases; 'A' pattern in 7 cases and hypotropia in 3 cases. The mean preoperative horizontal deviation was 52.5 PD, and the mean postoperative horizontal deviation was 2.37 PD (p = 0.028). The pre-operative vertical deviation was 18 PD and post-operative vertical deviation was 5 PD. MRI showed reduced IO muscle size; average area being 11.27 mm in the affected eyes, with normal sized inferior recti (average: 24.63 mm) and medial recti muscles (average: 30.08 mm). Surgical success was seen in all six cases. Average follow-up was 265 days. The Parks' three step test was not valid, except for one acquired unilateral case.
Isolated pareses of inferior oblique muscle exhibit defective elevation in adduction of the affected eye, 'A' pattern and fundus intorsion, and is confirmed by neuroimaging. These can be successfully managed surgically to correct the deviation.
描述孤立性下斜肌麻痹的病因、临床特征、影像学特征和治疗方法。
通过彻底的斜视检查和神经影像学检查，诊断为下斜肌麻痹。患者接受了可调节斜视手术或保守治疗。手术成功的定义为术后平均水平偏差在 10 棱镜度[PD]以内，垂直偏差在 5 PD 以内，在最后一次随访时。
7 例为先天性，6 例为双侧，6 例为内斜视；7 例为“A”型，3 例为下斜视。术前平均水平偏差为 52.5 PD，术后平均水平偏差为 2.37 PD（p=0.028）。术前垂直偏差为 18 PD，术后垂直偏差为 5 PD。MRI 显示下斜肌缩小；受累眼平均面积为 11.27mm，下直肌（平均：24.63mm）和内直肌正常（平均：30.08mm）。6 例手术均成功。平均随访 265 天。除了一例获得性单侧病例外，Parks 三步试验均无效。
孤立性下斜肌麻痹表现为受累眼内收时上提功能缺陷、A 型斜视和眼底扭转，神经影像学可明确诊断。这些可以通过手术成功矫正偏差。
