Surgical Management of Masquerading Superior Oblique Palsy
Year: 2025
Type: article
Study design: Observational Study
Abstract: PURPOSE: To compare the surgical outcomes between superior oblique (SO) palsy (SOP) and masquerading SO palsy (mSOP). DESIGN: Comparative interventional case series. METHODS: Medical records of patients with SOP and mSOP were reviewed from 1991 to 2024. Palsy cases had maximum SO cross section in the hypertropic eye no more than 80% of that in the fellow eye, whereas mSOP cases had bilaterally symmetric SO muscles on magnetic resonance imaging. Types of surgery and effect on hypertropia were compared between groups. RESULT: of the contralateral fellow (P < .0001), but was bilaterally symmetric in mSOP. Mean preoperative central gaze hypertropia was similar at 14.7±9.8Δ in SOP and 11.0±6.9Δ in mSOP (P = .2). The commonest surgery was ipsilateral inferior oblique (IO) weakening combined with contralateral inferior rectus (IR) recession, followed by ipsilateral IO weakening alone and contralateral IR recession alone. After 41±65 months' follow-up in SOP and 22±41 months in mSOP, central gaze hypertropia decreased from 14.7±9.8Δ to 1.7±4.1Δ in SOP, and from 11.0±6.9Δ to -2.9±5.4Δ in mSOP (both P < .0001). Surgical effect was similar at 13.2±10.3Δ in SOP and 14.1±10.0Δ in mSOP. Reoperation rate was low and similar in both groups. CONCLUSION: Clinical characteristics and surgical effect are similar in mSOP and SOP. Conventional surgeries are comparably effective in both. This suggests that mechanism beyond SO muscle function drive head tilt-dependent cylcovertical strabismus.
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
OpenAlex ID: W4407777126