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Clinical Features and Outcomes of Strabismus Treatment in Third Cranial Nerve Palsy during a 10-Year Period.

Bagheri A, Borhani M, Tavakoli M, Salehirad S - J Ophthalmic Vis Res (2014 Jul-Sep)

Bottom Line: We evaluated age, sex, laterality, severity of involvement, etiology, frequency of clinical findings, and types and results of treatments. 52 patients including 29 male and 23 female subjects with mean age of 21.1±15.5 years were studied between January 1999 and January 2009.The most common operation was large horizontal recession and resection in 78.2% of cases.Corresponding figures for mean vertical deviation were 13±15, 7±12, 4±6 and 1±2 PD, respectively.

View Article: PubMed Central - PubMed

Affiliation: Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

ABSTRACT

Purpose: To evaluate the demographics and management outcomes of strabismus surgery in patients with third cranial nerve palsy.

Methods: This retrospective study includes subjects with third cranial nerve palsy. We evaluated age, sex, laterality, severity of involvement, etiology, frequency of clinical findings, and types and results of treatments.

Results: 52 patients including 29 male and 23 female subjects with mean age of 21.1±15.5 years were studied between January 1999 and January 2009. Etiologies of third nerve palsy included congenital in 16 (30.8%), trauma in 26 (50%) and other causes in 10 (19.2%) patients. In 24 patients (46.2%), the palsy was complete. The most common type of strabismus was exotropia associated with hypotropia (40%). Medical treatment was used in 25 (48%) and surgical treatment in 46 (88.4%) subjects. One time strabismus surgery was performed in 30 (65.2%), 2 times in 11 (24%) and 3 times in 5 (10.8%) subjects. The most common operation was large horizontal recession and resection in 78.2% of cases. Mean horizontal deviation in primary position was 66±29 prism diopters (PD) before surgery decreasing to 21±19, 13±12 and 6±8 PD after first, second and third surgery, respectively. Corresponding figures for mean vertical deviation were 13±15, 7±12, 4±6 and 1±2 PD, respectively. Abnormal head posture was 10-30° in 11 (21.1%) cases before treatment which completely resolved after surgery.

Conclusion: Surgical management of strabismus in patients with third nerve palsy is difficult and challenging, however the majority of patients achieve ideal results with appropriate and stepwise surgical plans.

No MeSH data available.


Related in: MedlinePlus

A patient with strabismus surgery after traumatic third nerve paresis before (A) and after (B) surgery.
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Figure 2: A patient with strabismus surgery after traumatic third nerve paresis before (A) and after (B) surgery.

Mentions: In conclusion, in most of patients with third nerve palsy who underwent surgical treatment in the present study, the main etiology was trauma followed by congenital causes. Severe ptosis, pupillary involvement, and complex strabismus are common in patients with history of trauma. A sizable portion of patients needed more than one surgery. Ptosis correction is difficult and a large number of patients require multistep surgeries. Although surgical treatment of third nerve palsy is challenging because of multiple muscle involvement with complex deviation and presence of ptosis, choosing appropriate and sometimes multistep surgical plans helps achieve acceptable results [Figure 2].


Clinical Features and Outcomes of Strabismus Treatment in Third Cranial Nerve Palsy during a 10-Year Period.

Bagheri A, Borhani M, Tavakoli M, Salehirad S - J Ophthalmic Vis Res (2014 Jul-Sep)

A patient with strabismus surgery after traumatic third nerve paresis before (A) and after (B) surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4307654&req=5

Figure 2: A patient with strabismus surgery after traumatic third nerve paresis before (A) and after (B) surgery.
Mentions: In conclusion, in most of patients with third nerve palsy who underwent surgical treatment in the present study, the main etiology was trauma followed by congenital causes. Severe ptosis, pupillary involvement, and complex strabismus are common in patients with history of trauma. A sizable portion of patients needed more than one surgery. Ptosis correction is difficult and a large number of patients require multistep surgeries. Although surgical treatment of third nerve palsy is challenging because of multiple muscle involvement with complex deviation and presence of ptosis, choosing appropriate and sometimes multistep surgical plans helps achieve acceptable results [Figure 2].

Bottom Line: We evaluated age, sex, laterality, severity of involvement, etiology, frequency of clinical findings, and types and results of treatments. 52 patients including 29 male and 23 female subjects with mean age of 21.1±15.5 years were studied between January 1999 and January 2009.The most common operation was large horizontal recession and resection in 78.2% of cases.Corresponding figures for mean vertical deviation were 13±15, 7±12, 4±6 and 1±2 PD, respectively.

View Article: PubMed Central - PubMed

Affiliation: Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

ABSTRACT

Purpose: To evaluate the demographics and management outcomes of strabismus surgery in patients with third cranial nerve palsy.

Methods: This retrospective study includes subjects with third cranial nerve palsy. We evaluated age, sex, laterality, severity of involvement, etiology, frequency of clinical findings, and types and results of treatments.

Results: 52 patients including 29 male and 23 female subjects with mean age of 21.1±15.5 years were studied between January 1999 and January 2009. Etiologies of third nerve palsy included congenital in 16 (30.8%), trauma in 26 (50%) and other causes in 10 (19.2%) patients. In 24 patients (46.2%), the palsy was complete. The most common type of strabismus was exotropia associated with hypotropia (40%). Medical treatment was used in 25 (48%) and surgical treatment in 46 (88.4%) subjects. One time strabismus surgery was performed in 30 (65.2%), 2 times in 11 (24%) and 3 times in 5 (10.8%) subjects. The most common operation was large horizontal recession and resection in 78.2% of cases. Mean horizontal deviation in primary position was 66±29 prism diopters (PD) before surgery decreasing to 21±19, 13±12 and 6±8 PD after first, second and third surgery, respectively. Corresponding figures for mean vertical deviation were 13±15, 7±12, 4±6 and 1±2 PD, respectively. Abnormal head posture was 10-30° in 11 (21.1%) cases before treatment which completely resolved after surgery.

Conclusion: Surgical management of strabismus in patients with third nerve palsy is difficult and challenging, however the majority of patients achieve ideal results with appropriate and stepwise surgical plans.

No MeSH data available.


Related in: MedlinePlus