Comparison of ocular torsion between congenital and acquired unilateral superior oblique palsy

Kim, Dae Hee; Lim, Hyun Taek

doi:10.1038/s41433-019-0476-1

Cited by 10 publications

(12 citation statements)

References 13 publications

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“…In the study by Oh and Oh (10), all cases with decompensated causes were classified into the incomplete recovery group, and this may have influenced the higher vertical angle of deviation of the incomplete recovery group. These cases were not included in our study because decompensated palsy showed different clinical features and prognosis than those acquired palsies (13–15).…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics for Predicting Recovery of Acquired Fourth Cranial Nerve Palsy

Kim¹,

Choi²,

Jeon³

2021

Journal of Neuro-Ophthalmology

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Background:Fourth cranial nerve palsy is the most common disease diagnosed in patients with vertical diplopia. Although it is reported to present a good prognosis, there are currently no agreed on prognostic factors that anticipate the recovery of the palsy other than the etiology. The purpose of this study was to investigate the prognostic factors of acquired fourth cranial nerve palsy.Methods:The medical records of consecutive patients diagnosed with acquired unilateral fourth cranial nerve palsy from 2010 to 2020 and followed up for ≥6 months were retrospectively reviewed. The cause and degree of palsy, ocular deviation (horizontal, vertical, and cyclo), and fundus torsion were reviewed. The cause of palsy was classified as ischemic, traumatic, intracranial mass, others, or idiopathic. Patients were divided into 2 groups according to palsy recovery: complete recovery (group CR) or not CR (group NCR). The clinical characteristics of the 2 groups were compared, and the risk factors for incomplete recovery were investigated.Results:Thirty-five patients (25 men) were included in the study. The average age was 55.94 ± 16.11 years. CR was achieved in 23 patients (65.7%), and the time to recovery was 3.91 ± 4.03 months. The most common cause was traumatic (40.0%), followed by ischemia (37.1%), intracranial mass (11.4%), others (8.6%), and idiopathic (2.9%). The degree of palsy and fundus torsion was significantly higher in group NCR (P = 0.010 and P = 0.001). Severe oculomotor limitation, large fundus torsion, and intracranial mass cause rather than ischemic cause indicated a higher risk of incomplete or no recovery (P = 0.016, P = 0.009, and P = 0.043).Conclusion:Identifying whether a patient has an intracranial mass, severe oculomotor limitation, or large fundus excyclotorsion may be useful for predicting the recovery of acquired unilateral fourth cranial nerve palsy.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics for Predicting Recovery of Acquired Fourth Cranial Nerve Palsy

Kim¹,

Choi²,

Jeon³

2021

Journal of Neuro-Ophthalmology

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“…In the literature, congenital unilateral SOP has been shown to cause higher fundus torsion than is acquired. Kim et al [ 8 ] showed that fundus torsion in congenital unilateral SOP is more common in nonparetic eyes. In the study by Kim et al [ 8 ], 61.1% of congenital unilateral SOP patients and 46.5% of acquired USOP patients showed extortion in both eyes.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effect of unilateral and bilateral inferior oblique myectomy on fundus torsion in primary and secondary inferior oblique overaction

Yilmaz

2023

North Clin Istanbul

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OBJECTIVE This article evaluates the effects of unilateral and bilateral inferior oblique myectomy (IOM) on fundus torsion in primary and secondary inferior oblique overaction (IOOA). METHODS This study analyzed 230 OCT images of 53 eyes of 32 patients who had undergone IOM by a single surgeon in the last two years. The disc-foveal angle (DFA) was calculated by digitally measuring the angle between the horizontal line passing through the geometric center of the optic disc and the curved line connecting the fovea to the geometric center of the optic disc. DFA was classified into intorsion, normal torsion, and extortion. The DFA was measured from the OCT images before the operation in the first week, first month, third month, and sixth month. RESULTS When all the patients in our study were evaluated together, IOM statistically reduced the mean DFA in the third month (p=0.00). The DFA was higher in the secondary IOOA group than in the primary IOOA group (p=0.24). Bilateral IOM statistically significantly reduced DFA in the third month (p=0.00) and decreased the DFA difference between the two eyes in the third month (p=0.583). Unilateral IOM increased the DFA, rather than decreasing it, in the first week in operated eyes (p=0594) and increased the DFA difference between the two eyes after surgery (p=0.477). When we evaluated the localization of the macula as an intorsion, normal intorsion, or extortion, the extortion decreased from 36 to nine in the third month after bilateral IOM, and intorsion was seen in only two. Unilateral surgery did not significantly change fundus torsion in primary IOOA, and it caused intorsion in 3 of 6 (50%) operated eyes in secondary IOOA. CONCLUSION Although unilateral IOM provides a clinical improvement in secondary IOOA, it increases the difference in DFA between both eyes and causes intorsion in 50% of patients. Masked IOOA was detected in 3 of 11 (27.3%) patients who underwent unilateral IOM. When deciding on unilateral surgery, the possibility of increased DFA difference between both eyes, intorsion in the operated eye, and masked IOOA in the other eye should be considered.

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“…Kim and Lim [ 14 ] compared ocular torsion between patients with congenital and acquired unilateral SOP. In this study, patients with SOP had variable fundus torsion of varying etiologies.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, patients with SOP had variable fundus torsion of varying etiologies. They suggested that unilateral SOP might initially induce paretic ocular extorsion and then induce ocular dominance, cyclofusion, or a neural adaptation mechanism in the nonparetic eye, increasing the total amount of extorsion in both eyes [ 14 , 15 ]. We suspected that more severe nerve damage leads had a greater effect on compensatory ocular torsion mechanisms and results in more fundus extorsion in the nonparetic eye.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Recovery of Traumatic Unilateral Superior Oblique Palsy and Ocular Factors for Predicting Prognosis

Park

Lee

Kim

et al. 2022

Korean J Ophthalmol

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Purpose: This study evaluated the prognosis of patients with traumatic unilateral superior oblique palsy (SOP) and clinical factors associated with spontaneous resolution.Methods: Medical records of patients with traumatic unilateral SOP who visited two hospitals (*** and *** Hospital) between January 2015 and June 2020 were reviewed retrospectively. When traumatic unilateral SOP did not recover within at least 1 year of follow-up, no spontaneous resolution was considered. Both traumatic and ocular factors were evaluated to evaluate their association with spontaneous recovery.Results: Fifty-nine patients (mean age: 52.6 years, 48 men) were enrolled in this study. The mean interval from trauma to initial presentation was 3.9 months. The mean vertical deviation at initial presentation was 6.34 ± 5.22 (range: 0-25) PD. During the mean 24.1-month follow-up period, 28 (47.5%) patients achieved spontaneous resolution of SOP. Thirteen patients underwent surgical treatment for SOP. Vertical deviation <6 PD at the initial visit and low fundus torsion in the non-paretic eye and both eyes were significantly associated with spontaneous recovery (p < 0.05, logistic regression analysis). Traumatic factors, including the trauma type, presence of intracranial lesion, loss of consciousness, and Glasgow Coma Scale score, were not associated with spontaneous recovery. Conclusions:In this multi-center study, spontaneously recovery was achieved in 47.5% patients with traumatic unilateral SOP. Even mild head trauma can lead to permanent SOP. Ocular factors, including the angle of deviation and fundus torsion, may better predict spontaneous resolution than traumatic factors in patients with traumatic unilateral SOP.

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Comparison of ocular torsion between congenital and acquired unilateral superior oblique palsy

Cited by 10 publications

References 13 publications

Clinical Characteristics for Predicting Recovery of Acquired Fourth Cranial Nerve Palsy

Clinical Characteristics for Predicting Recovery of Acquired Fourth Cranial Nerve Palsy

Evaluation of the effect of unilateral and bilateral inferior oblique myectomy on fundus torsion in primary and secondary inferior oblique overaction

Spontaneous Recovery of Traumatic Unilateral Superior Oblique Palsy and Ocular Factors for Predicting Prognosis

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