title: Modified Harada-Ito procedure in bilateral superior oblique paresis.
abstract: BACKGROUND
  Patients with bilateral superior oblique palsies may complain of diplopia and torsion, especially in downgaze. They are difficult to manage surgically, although bilateral modified Harada-Ito procedures may be of value.
  
  
  METHODS
  A retrospective review was carried out of patients treated with bilateral Fells' modified Harada-Ito procedures for bilateral superior oblique palsy between 1989 and March 2000, the patients being identified from operating records.
  
  
  RESULTS
  Twenty-three patients were identified (9 females and 14 males) with a mean age at presentation of 37 years (range 19 to 75). In 20 cases (87%) the aetiology was trauma (14 due to traffic accidents). All patients had diplopia at presentation (3 specifically mentioned torsion) with a mean duration of 22.5 months. Eleven patients had abnormal head postures and 13 were binocular. Mean vertical deviation was 3.2(delta)for distance and 4(delta)for near. Maximum torsion ranged from 5 degrees (previous surgery) to 24 degrees excylotorsion with a mean of 13 degrees. Thirteen patients had a V pattern. After surgery the mean vertical deviation was 1.5(delta )for distance and 1(delta)for near. Ten patients were symptom free, 8 had reduced diplopia and 5 were unchanged. The worst torsion post-op ranged from 1 degrees of intorsion to 11 degrees of excyclotorsion (mean 4 degrees ). Further vertical muscle surgery was required in 10 (43%) patients. Mean follow-up was 13.5 months.
  
  
  CONCLUSIONS
  In these patients bilateral modified Harada-Ito procedures successfully reduced torsion and decreased symptoms. Many patients require subsequent surgery to improve other aspects of their motility problem.
authors.affiliation: Moorfields Eye Hospital, London, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Roberts
authors.forename: Emma
authors.initials: E
authors.lastname: Dawson
authors.forename: John
authors.initials: J
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009886:Ophthalmoplegia / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015348:Vision, Binocular