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Masked bilateral superior oblique palsy.
Faisal Esmail1, Michael Flanders
1Department of Ophthalmology, McGill University Health Centre, Montreal General and Montreal Children's hospitals, Montreal, Que.
Canadian Journal of Ophthalmology. Journal Canadien D'Ophtalmologie
|November 19, 2003
Summary
Masked bilateral superior oblique palsy (MBSOP) can develop in the unaffected eye after surgery for unilateral superior oblique palsy (SOP). Surgical outcomes for MBSOP are generally successful, with improved alignment and restored binocular vision.
Area of Science:
- Ophthalmology
- Strabismus Surgery
- Pediatric Ophthalmology
Background:
- Masked bilateral superior oblique palsy (MBSOP) is diagnosed when the previously unaffected eye shows signs of superior oblique palsy (SOP) after surgery for SOP in the other eye.
- Up to 10% of patients undergoing SOP surgery may develop MBSOP, even without prior bilateral signs.
Purpose of the Study:
- To examine the clinical profiles and surgical management outcomes of 14 patients diagnosed with MBSOP.
Main Methods:
- Retrospective analysis of 14 patients' records with MBSOP criteria.
- Data extracted included pre- and postoperative ophthalmic/orthoptic examinations, surgical procedures, and outcomes.
- Success defined as normal head posture, no diplopia in functional gaze, and alignment within 5 prism diopters (PD).
Main Results:
- All patients initially presented with unilateral SOP; 14% developed MBSOP post-surgery.
- Preoperative hypertropia averaged 17 PD, with 93% exhibiting head tilt, V pattern, and oblique muscle dysfunction.
- Post-second surgery, 9 out of 10 patients achieved excellent alignment (within 6 PD) and restored binocular vision.
Conclusions:
- MBSOP is challenging to detect preoperatively but should be considered in unilateral SOP cases.
- Informing patients about the potential for contralateral palsy is crucial.
- Surgical intervention for evident MBSOP typically leads to successful outcomes.