Srimanan Worapot
Division of Ophthalmology, Phramongkutklao Hospital, Bangkok, Thailand.
Clin Ophthalmol. 2025 May 5;19:1489-1503. doi: 10.2147/OPTH.S525257. eCollection 2025.
Trochlear nerve palsy is a common cause of double vision, particularly vertical diplopia. Surgery might be necessary if the condition does not improve independently. The success of the surgery can vary based on the method employed, and clear factors to predict its effectiveness are not evident. This study evaluates surgical techniques, success rates, and prognostic factors for trochlear nerve palsy at a tertiary hospital.
A retrospective chart review was conducted on patients undergoing strabismus surgery for trochlear nerve palsy at Phramongkutklao Hospital between April 2012 and July 2024. Collected data included demographics, visual acuity, stereopsis, etiology, preoperative angles, surgical methods, and postoperative outcomes. A literature review regarding surgical success and prognostic factors was also conducted.
Seventy-two cases were included, with 79.2% involving decompensated congenital trochlear nerve palsy. The overall surgical success rate was 76.39%, and inferior oblique myectomy was the most common and effective procedure (44.4% of cases). Based on multivariate logistic regression analysis, a preoperative hypertropia of ≤15 prism diopters was the significant factor for predicting successful outcomes in this study (OR 5.13, 95% CI 1.19-22.18).
Inferior oblique muscle surgery effectively addresses small-angle deviations in trochlear nerve palsy. A <15 prism diopters vertical deviation strongly predicted positive surgical outcomes in this study. Further studies are needed to compare surgical techniques and explore additional prognostic factors to optimize long-term outcomes and improve patient care.
滑车神经麻痹是复视的常见原因，尤其是垂直性复视。如果病情不能自行改善，可能需要进行手术。手术的成功率可能因采用的方法而异，且尚无明确的预测其有效性的因素。本研究评估了一家三级医院滑车神经麻痹的手术技术、成功率和预后因素。
对2012年4月至2024年7月在佛统府医院接受滑车神经麻痹斜视手术的患者进行回顾性病历审查。收集的数据包括人口统计学资料、视力、立体视、病因、术前角度、手术方法和术后结果。还进行了关于手术成功率和预后因素的文献综述。
纳入72例病例，其中79.2%为失代偿性先天性滑车神经麻痹。总体手术成功率为76.39%，下斜肌切除术是最常见且有效的手术（占病例的44.4%）。基于多因素逻辑回归分析，术前上斜视≤15棱镜度是本研究中预测手术成功结果的重要因素（比值比5.13，95%可信区间1.19 - 22.18）。
下斜肌手术可有效解决滑车神经麻痹中的小角度偏差。本研究中垂直偏差<15棱镜度强烈预测手术结果良好。需要进一步研究以比较手术技术并探索其他预后因素，以优化长期结果并改善患者护理。
