Clinical factors underlying a single surgery or repetitive surgeries to treat superior oblique muscle palsy

The purpose of this study is to know clinical factors underlying either a single surgery or repetitive surgeries, required to treat superior oblique muscle palsy. Retrospective review was made on 246 consecutive patients with idiopathic (n = 212) or acquired (n = 34) superior oblique muscle palsy who underwent surgeries in 8 years at one institution. Idiopathic palsy included congenital and decompensated palsies while acquired palsy included traumatic and ischemic palsies. Clinical factors, compared between groups with a single surgery (n = 203) and two or more surgeries (n = 43), were surgical methods, sex, age at surgery, horizontal, vertical, and cyclotorsional deviations, and stereopsis at near fixation. Inferior oblique muscle recession on paretic side was chosen in about 60% of the single-surgery and repetitive-surgery group as an initial surgery, followed by inferior rectus muscle recession on non-paretic side. The age at surgery was significantly older, vertical and cyclotorsional deviations were significantly larger in the repetitive-surgery group, compared with the single-surgery group (P = 0.01, P < 0.001, P = 0.02, Mann-Whitney U-test, respectively). The 95% confidence interval of vertical deviations was 15-17 prism diopters in the single-surgery group and 23-28 prism diopters in the repetitive surgery group. Significant differences in vertical deviations were replicated also in subgroups of patients with either idiopathic or acquired palsy. In conclusions, the 95% confidence interval of vertical deviations, determined by alternate prism and cover test, would be used as a common benchmark for predicting either a single surgery or repetitive surgeries, required to treat idiopathic and acquired superior oblique muscle palsy, in the process of obtaining the informed consent

Postural Stability Changes during Large Vertical Diplopia Induced by Prism Wear in Normal Subjects

To test the effect of double vision on postural stability, we measured postural stability by electric stabilometry before prism-wearing and immediately, 15, 30, and 60min after continuous prism-wearing with 6 prism diopters in total (a 3-prism-diopter prism placed with the base up in front of one eye and with the base down in front of the other eye) in 20 normal adult individuals with their eyes open or closed. Changes in stabilometric parameters in the time course of 60min were analyzed statistically by repeated-measure analysis of variance. When subjectsｾ eyes were closed, the total linear length (cm) and the unit-time length (cm/sec) of the sway path were significantly shortened during the 60-minute prism-wearing (p＜0.05). No significant change was noted in any stabilometric parameters obtained with the eyes open during the time course. In conclusion, postural stability did not change with the eyes open in the condition of large vertical diplopia, induced by prism-wearing for 60min, while the stability became better when measured with the eyes closed. A postural control mechanism other than that derived from visual input might be reinforced under abnormal visual input such as non-fusionable diplopia

Outcomes of binocular treatment using a Bangerter occlusion film and computer games in patients with intractable unilateral amblyopia

　To report outcomes following binocular treatment using a Bangerter occlusion filter (BF) and computer games in patients with intractable amblyopia.METHODS: Eight patients (4 boys, mean ± SD age: 8.0 ± 0.8 years) with unilateral amblyopia that did not respond to conventional treatments were studied. They were instructed to play action games for one hour a day while wearing spectacles with an adequate level of BF in front of the non-amblyopic eye so that the visual input became the same between the two eyes. They continued this exercise for eight weeks, and we assessed their visual acuity and spatial sensitivity at baseline, and at 4- and 8-week visits. To confirm the maintenance of efficacy after the treatment, we assessed them again at a 12-week visit.　RESULTS: The mean log MAR at distance improved from 0.32 to 0.24 at the 4-week visit (p < 0.05), and appeared to continue up to eight weeks, but returned to the baseline level at the 12-week visit (four weeks after terminating the treatment). There was no significant improvement in the mean log MAR at near. Contrast sensitivity significantly improved only at three cycles/ degree (p < 0.05), and this effect persisted until the 12-week visit. The distance log MAR at the 12-week visit had a significant correlation with the strength of suppression for the amblyopic eye at baseline (r = 0.71, p < 0.05).　CONCLUSIONS: Binocular treatment improved visual function only in terms of contrast sensitivity at low spatial frequency. Patients who have weak suppression may gain some benefit from this treatment

Outcomes of binocular treatment using a Bangerter occlusion film and computer games in patients with intractable unilateral amblyopia

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