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KMID : 0360220140550121883
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Journal of the Korean Ophthalmological Society
2014 Volume.55 No. 12 p.1883 ~ p.1889
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Correction of Hypertropia Coexisting with Intermittent Exotropia
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Cho Kwan-Hyuk
Lee Joo-Yeon
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Abstract
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Purpose: To investigate the clinical features associated with hypertropia and report the surgical outcomes of hypertropia coexisting with exotropia.
Methods: We reviewed the medical records of 148 patients with intermittent exotropia coexisting with hypertropia over 4 PD who received exotropia surgery. The cases accompanied by apparent paralytic strabismus such as superior oblique palsy were excluded. Patients were divided into groupⅠ(clinically diagnosed hypertropia) and group Ⅱ (non-specific hypertropia) and the clinical features of coexisting hypertropia and surgical outcomes were analyzed.
Results: Among the 148 patients, groupⅠconsisted of 38 patients (26%) and group Ⅱ of 110 patients (74%). The average amount of preoperative hypertropia angle in primary gaze was 9.58 ± 3.89 PD and 6.62 ± 2.69 PD in group Ⅰ and Ⅱ, respectively. Group Ⅰ included 12 patients with dissociated vertical deviation (DVD), 10 patients with unilateral inferior oblique overaction, 13 patients with asymmetric bilateral inferior oblique overaction and 3 patients with superior oblique overaction. Group Ⅱ included 19 patients with comitant hypertropia (17%), head tilt positive pattern (simulated superior oblique palsy) was found in 84 patients (76.3%) and variable incomitance was observed. In groupⅠ, 29 patients received simultaneous horizontal muscle with hypertropia surgery. Postoperative hypertropia angle in groupⅠ was 1.41 ± 2.93 PD and 4 cases were considered surgical failure. In groupⅡ, hypertropia was resolved with horizontal muscle surgery only and the amount of postoperative hypertropia was 0.45 ± 1.60 PD.
Conclusions: In this study, vertical deviations in intermittent exotropia with concomitant hypertropia related to obvious oblique muscle dysfunction or DVD were corrected effectively by oblique or vertical rectus muscle surgery. Nonspecific hypertropia can be resolved after horizontal muscle surgery alone, however, for precise differential diagnosis, careful examination for variable clinical features is necessary before determining surgery.
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KEYWORD
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Hypertropia, Intermittent exotropia, Oblique muscle dysfunction, Simulated superior oblique palsy
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