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| Application of Superior Oblique Split Tendon Lengthening in A-Pattern Strabismus Caused by Superior Oblique Overaction |
| Jiong Dong, Lixia Feng, Lin Xia, Sha Luo, Feng Wang, Bingying Zhao |
| Department of Ophthalmology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China |
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Abstract Objective: To investigate the safety and effectiveness of superior oblique split tendon lengthening in the treatment of A-pattern strabismus with superior oblique overaction. Methods: In this retrospective study, the clinical date of 8 cases (14 eyes), who underwent superior oblique split tendon lengthening from June 2020 to June 2021 in the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. All patients were treated with superior oblique split tendon lengthening according to the degree of superior oblique overaction, and the lengthening 4-5 mm for superior oblique overaction +1, 5-6 mm for +2, 7-8 mm for +3 and 8-10 mm for +4. To observe the effect of operation on A-pattern strabismus,objective eye rotation and stereoscopic vision, paired t test was used for normal distribution data, Mann Whitney test was used for non-normal distribution data, Spearman rank correlation test were used for analyze the correlation between two variables. Results: Eight cases (14 eyes) were treated with superior oblique split tendon lengthening and horizontal strabismus correction. Two patients underwent unilateral superior oblique split tendon lengthening, and six patients underwent bilaterally superior oblique split tendon lengthening. Except 1 patient, all the patients had no A pattern after surgery. Postoperative A-patterns was significantly reduced in all patients compared with preoperative. The average difference of pre- and post-operative A-patterns were 22.5±9.4 PD and 3.3±10.1 PD in 6 cases with bilaterally superior oblique overaction (t=10.78, P<0.001). The bilaterally superior oblique split tendon procedure could correct A-pattern in an amount of (19.2±4.4) PD. The average amount of pre-and post-operation superior oblique overaction were 2.0 (2.0-3.0) and +0 (0-0.2) in 14 eyes (U=6.50, P<0.001); Objective rotation was measured by image-proplus 6.0 software. In 14 eyes, the torsion was significantly improved after the operation compared with preoperative. The average pre-and post-operation objective rotation were +5.7°±5.7° and -0.6°±6.0° in 14 eyes (t=6.98, P<0.001). The average corrected rotation was 6.3°±3.4°. None of the patients had secondary superior oblique palsy and V-pattern after surgery. All patients had no stereopsis in the original position before surgery, 2 patients received original peripheral stereoscopic vision (400 ") and 1 patient received fovea stereoscopic vision (20 "). Conclusions: Superior oblique split tendon lengthening is effective in the treatment of superior oblique overaction and A-pattern, which can correct objectively in-torsion and stereoscopic vision of some patients, and is less likely to cause secondary complications such as superior oblique palsy.
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Received: 17 February 2022
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Corresponding Authors:
Lixia Feng, Department of Ophthalmology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China (Email: lixiafeng@163.com)
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