Types of Surgery Performed and Reoperation Rate for Congenital Superior Oblique Palsy: a Claims Database Study

Abstract

Purpose: To investigate types of surgeries performed to treat a presumed congenital superior oblique palsy (SOP) and the reoperation rate. Methods: This was a population-based retrospective cohort study using claims data from the United States. Patients who underwent strabismus surgery for a presumed congenital SOP with ≥ 3 months of continuous enrolment after the initial surgery were included. We investigated age, surgical methods and the time interval between the initial surgery and reoperation. The hazard ratios for reoperation were estimated according to the surgical methods using Cox regression analysis. Results: A total of 3,998 patients underwent surgery for presumed congenital SOP; 2,981 (74.6%) on only one vertical muscle (excluding superior oblique). Reoperation was performed on 427 patients (10.7%). Compared to patients who underwent unilateral surgery on one vertical muscle (excluding superior oblique muscle), patients who underwent surgery that included the superior oblique muscle (unilateral 2.08; 95% CI, 1.61-2.67, p < 0.001; bilateral 2.44; 95% CI, 1.40-4.28, p = 0.002) and two or more vertical muscles (excluding the superior oblique muscle) (unilateral 2.99; 95% CI, 2.00-4.49, p < 0.001; bilateral 1.68; 95% CI, 1.23-2.28, p = 0.001) had increased hazard ratios for reoperation. The median period between the initial surgery and reoperation was 168.0 [Q1-Q3 84.0-407.8] days and negatively correlated with patient age at initial surgery (r = À0.199, p < 0.001). Conclusion:The reoperation rate for presumed congenital SOP was 10.7%. Patients who underwent surgery on two or more vertical muscles or the superior oblique muscle had an increased risk of reoperation.

Superior Oblique Muscle Palsy: Clinical Characteristics and Surgical Approach in 1057 Patients

“…The current study was to evaluate the clinical characteristics of 1057 subjects with SOP. Except for Heo et al study, (31) other published articles regarding SOP, have a signi cantly small sample size compared present study. Albeit Heo et al (31) study was conducted using claims data that excluded the patients with acquired SOP and did not provide information on the angle of deviation, presence of abnormal head posture or visual acuity.…”

“…Except for Heo et al study, (31) other published articles regarding SOP, have a signi cantly small sample size compared present study. Albeit Heo et al (31) study was conducted using claims data that excluded the patients with acquired SOP and did not provide information on the angle of deviation, presence of abnormal head posture or visual acuity. The higher number of patients in this study, compared to previous studies, allows us to report the results of data analysis with greater accuracy.…”

“…In their study, patients who underwent surgery that included the superior oblique muscle or patients who had surgery on more than one vertical muscle (excluding superior oblique muscle) had increased hazard ratios for reoperation. (31) Signi cant horizontal deviation, the CDVA difference between eyes and the presence of amblyopia, were factors that increased the chance of needing two or more times surgery in the present study.…”

Clinical characteristics and surgical outcomes in patients with superior oblique muscle palsy: a retrospective study on 1057 patients

“…Except for the study by Heo et al [ 18 ], other published articles regarding SOP have a significantly small sample size compared to the present study. Albeit Heo et al [ 25 ] study was conducted using claims data that excluded the patients with acquired SOP and did not provide information on the angle of deviation, presence of abnormal head posture or visual acuity. Compared to previous studies, the higher number of patients in this study allows us to report the results of data analysis with greater accuracy.…”

“…In the recently published cohort study by Heo et al, the reoperation rate for SOP was 10.7% which is close to our finding. In their study, patients who underwent surgery that included the superior oblique muscle or patients who had surgery on more than one vertical muscle (excluding superior oblique muscle) had increased hazard ratios for reoperation [ 25 ]. Significant horizontal deviation, the CDVA difference between eyes and the presence of amblyopia, were factors that increased the chance of needing two or more times surgery in the present study.…”