PubMed ID: 19716737
Author(s): Agarwal S, Kushner BJ. Results of extraocular muscle surgery for superior oblique myokymia. J AAPOS. 2009 Oct;13(5):472-6. doi: 10.1016/j.jaapos.2009.05.012. Epub 2009 Aug 28. PMID 19716737
Journal: Journal Of Aapos : The Official Publication Of The American Association For Pediatric Ophthalmology And Strabismus, Volume 13, Issue 5, Oct 2009
PURPOSE To report results of extraocular muscle surgery for superior oblique myokymia when medical treatment fails.
METHODS A retrospective review of 14 consecutive patients undergoing superior oblique tenectomy and inferior oblique myectomy between 1976 and 2008.
RESULTS The mean age of onset of symptoms was 35.4 +/- 12.6 years (range, 16-59.5), with a mean duration of oscillopsia of 5 +/- 4 years (range, 1.5-17) prior to surgery. Medical treatment was unsuccessful in all 14. Preoperatively, 2 had a small hypertropia that was consistent with an ipsilateral fourth (trochlear) nerve palsy; 12 had no manifest tropia. Postoperatively, all had complete elimination of oscillopsia, and 12 of 14 were free of diplopia in the primary position at 6 meters and 1/3 meter. The only 2 with diplopia in the primary position after surgery were the 2 with a manifest hypertropia preoperatively. Of the remaining 12 patients, 5 had a hypertropia of the affected eye limited to downgaze after surgery (mean of 6.2(Delta) +/- 1.6(Delta)). Of the 5, 3 needed contralateral inferior rectus surgery, and 1 required prism for downgaze. The mean follow-up was 4.1 +/- 2.4 years (range, 0.5-10). At the final visit, none had oscillopsia or uncontrolled diplopia, but 3 (21%) needed prisms.
CONCLUSIONS Superior oblique tenectomy and inferior oblique myectomy effectively eliminate oscillopsia associated with superior oblique myokymia but result in diplopia in downgaze in approximately 36% of patients, which may cause symptoms in patients who require a bifocal for near work.