[Changes in subjective cyclodeviation and objective cycloposition after modified Harada-Ito operation in acquired trochlear paralysis].
BACKGROUND
After recently published own investigations on subjective and objective cyclorotatory changes following inferior oblique recession for inferior oblique overaction, it was our aim to determine and to compare subjective and objective cyclorotatory changes following a modified Harada-Ito procedure for acquired trochlear palsy.


METHODS
Eight patients suffering from acquired uni-(n = 3) or bilateral (n = 5) trochlear palsy were investigated before surgery and 1 day, 3 days and 4 months after surgery. Subjective cyclodeviation was assessed by Harms' tangent scale. Objective cycloposition was measured by means of fundus cyclometry using an infrared Scanning Laser Ophthalmoscope.


RESULTS
The immediate postoperative incyclorotatory effect was 12 degrees in the unilateral group and 18 degrees in the bilateral group. Subjective and objective changes were nearly equal in both groups, with a subjective over-effect of 1 degree. After two days of binocular stimulation a marked regression of the surgical effect was found which still increased after four months. The long term incyclorotatory effect was subjectively and objectively nearly equal in the unilateral group which showed a relaps of subjective excyclodeviation of 5 degrees: in the bilateral group, the subjective effect was more pronounced than the objective effect, the immediate postoperative over-effect being disappeared.


CONCLUSIONS
In contrast to our results concerning inferior oblique muscle recession for strabismus sursoadductorius, subjective and objective cyclorotatory changes did not differ grossly following a modified Harada-Ito procedure. Subjective and objective short and long term regression was confirmed which objectively exceeded the amount of over-correction. As the underlying cause mechanical and sensory mechanisms are discussed.
Schworm
H D
HD
Sektion Strabologie und Kinderophthalmologie, Ludwig Maximilians Universität.
Horstmann
S
S
Ring
T
T
Boergen
K P
KP
D000328:Adult; D000368:Aged; D003290:Convergence, Ocular / Q000502:physiology; D003389:Cranial Nerve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D016489:Head Injuries, Closed / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009886:Ophthalmoplegia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D009887:Ophthalmoscopy; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D016896:Treatment Outcome; D014321:Trochlear Nerve / Q000503:physiopathology; D061247:Trochlear Nerve Injuries; D014787:Vision Tests; D015348:Vision, Binocular / Q000502:physiology
Anderungen der subjektiven Zyklodeviation und der objektiven Zykloposition nach modifizierter Harada-Ito-Operation bei erworbener Trochlearisparese.