Quantitative eye movement recordings in a patient with acquired bilateral superior oblique palsy before and after a bilateral Harada-Ito procedure.
OBJECTIVE
We examined the effects of the Harada-Ito procedure on static and dynamic alignment in an adult with acquired bilateral superior oblique palsy (SOP).


METHODS
3D eye movements were recorded before and six weeks after a bilateral Harada-Ito procedure. Superior oblique muscle (SOM) size and contractility were assessed with orbital imaging.


RESULTS
On MRI, the left SOM was smaller than the right. Little contractile thickening was present in down gaze for either eye. Preoperatively, the patient had a hypertropia: 1.9 degrees right hypertropia (at down 20 degrees , left 20 degrees ) and 6.4 degrees left hypertropia (at down 20 degrees , right 20 degrees ). Postoperatively, the vertical tropia in all positions was < 1 degrees . Listing's primary position rotated toward straight ahead for the RE but was unchanged for the LE. Postoperatively, for 40 degrees upward saccades peak dynamic intrasaccadic extorsion decreased by 2.2-3.2 degrees for both eyes and for 40 degrees downward saccades by 2.3-3.6 degrees for the RE but was unchanged for the LE. Saccade conjugacy improved and post-saccadic drift lessened for all vertical saccades.


CONCLUSIONS
The Harada-Ito procedure produced striking improvements in static and dynamic alignment in bilateral SOP. Some changes were binocular (decreased post-saccadic drift, improved saccade conjugacy, less dynamic extorsion for upward saccades) but others were much greater in the less paretic eye (torsional gradients from up to down gaze, less dynamic extorsion for downward saccades). Both central adaptive and peripheral mechanical changes explain these findings. Our results also imply that the Harada-Ito procedure has more effect when there is residual function of the SOM.
Ying
Howard S
HS
Department of Ophthalmology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. hying1@jhmi.edu
Darbandi
Bejan
B
Shan
Xiaoyan
X
Barker
Peter
P
Miller
Neil R
NR
Zee
David S
DS
D005133:Eye Movements; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011184:Postoperative Period; D020432:Trochlear Nerve Diseases / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*