Surgical management of Helveston syndrome (triad of A- pattern exotropia, superior oblique overaction and dissociated vertical deviation) using 'Four Oblique' procedure
Purpose: To report the surgical outcomes in six patients of Helveston syndrome using a “four oblique” procedure. The popular methods for surgical management include superior rectus recessions alone or combined with superior oblique tenectomy. However, large angle exotropia correction would entail a...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2020-01-01
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| Series: | Indian Journal of Ophthalmology |
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| Online Access: | http://www.ijo.in/article.asp?issn=0301-4738;year=2020;volume=68;issue=1;spage=170;epage=173;aulast=Agashe |
| _version_ | 1819101793023426560 |
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| author | Prachi Agashe Ashish Doshi |
| author_facet | Prachi Agashe Ashish Doshi |
| author_sort | Prachi Agashe |
| collection | DOAJ |
| description | Purpose: To report the surgical outcomes in six patients of Helveston syndrome using a “four oblique” procedure. The popular methods for surgical management include superior rectus recessions alone or combined with superior oblique tenectomy. However, large angle exotropia correction would entail a higher risk of anterior segment ischemia when the superior rectus needs to be operated along with the horizontal recti. Hence, we evaluated the long-term results of this uncommon procedure. Methods: This was a retrospective review of six patients diagnosed to have manifest dissociated vertical deviation (DVD) with A pattern exotropia with bilateral superior oblique over action. All patients underwent horizontal muscle recessions/resections for exotropia along with bilateral posterior tenectomy of the superior oblique with inferior oblique anterior transpositioning. Results: The median age was 10 years (Range 5–26 years). The mean postoperative follow-up was 26 ± 14.02 months (Range 12–48 months). The mean reduction in exotropia was from 36.5 ± 21.06 PD (Range 15–65 PD) to 6.1 ± 3.06 PD (Range 3–10 PD). The procedure corrected the A pattern from a mean 23 ± 7 PD (Range 15–35 PD) to 7.6 ± 3.2 PD (Range 3–10 PD). The average DVD in the right eye reduced from 14 ± 4.3 PD (Range 8–20 PD) to 5.3 ± 1.2 PD and in the left eye from 14.33 ± 3.6 PD (Range 10–18 PD) to 4.1 ± 1.1 PD. The DVD asymmetry reduced from 6.33 ± 3.4 PD to 1.5 ± 1.3 PD. Conclusion:”Four oblique” procedure with horizontal muscle surgery seems to be an effective method for significantly correcting the A pattern as well as reducing the DVD with good long-term outcome in our case series. |
| first_indexed | 2024-12-22T01:24:18Z |
| format | Article |
| id | doaj.art-0388950aef814ab6a34d09839895ec99 |
| institution | Directory Open Access Journal |
| issn | 0301-4738 1998-3689 |
| language | English |
| last_indexed | 2024-12-22T01:24:18Z |
| publishDate | 2020-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Ophthalmology |
| spelling | doaj.art-0388950aef814ab6a34d09839895ec992022-12-21T18:43:39ZengWolters Kluwer Medknow PublicationsIndian Journal of Ophthalmology0301-47381998-36892020-01-0168117017310.4103/ijo.IJO_196_19Surgical management of Helveston syndrome (triad of A- pattern exotropia, superior oblique overaction and dissociated vertical deviation) using 'Four Oblique' procedurePrachi AgasheAshish DoshiPurpose: To report the surgical outcomes in six patients of Helveston syndrome using a “four oblique” procedure. The popular methods for surgical management include superior rectus recessions alone or combined with superior oblique tenectomy. However, large angle exotropia correction would entail a higher risk of anterior segment ischemia when the superior rectus needs to be operated along with the horizontal recti. Hence, we evaluated the long-term results of this uncommon procedure. Methods: This was a retrospective review of six patients diagnosed to have manifest dissociated vertical deviation (DVD) with A pattern exotropia with bilateral superior oblique over action. All patients underwent horizontal muscle recessions/resections for exotropia along with bilateral posterior tenectomy of the superior oblique with inferior oblique anterior transpositioning. Results: The median age was 10 years (Range 5–26 years). The mean postoperative follow-up was 26 ± 14.02 months (Range 12–48 months). The mean reduction in exotropia was from 36.5 ± 21.06 PD (Range 15–65 PD) to 6.1 ± 3.06 PD (Range 3–10 PD). The procedure corrected the A pattern from a mean 23 ± 7 PD (Range 15–35 PD) to 7.6 ± 3.2 PD (Range 3–10 PD). The average DVD in the right eye reduced from 14 ± 4.3 PD (Range 8–20 PD) to 5.3 ± 1.2 PD and in the left eye from 14.33 ± 3.6 PD (Range 10–18 PD) to 4.1 ± 1.1 PD. The DVD asymmetry reduced from 6.33 ± 3.4 PD to 1.5 ± 1.3 PD. Conclusion:”Four oblique” procedure with horizontal muscle surgery seems to be an effective method for significantly correcting the A pattern as well as reducing the DVD with good long-term outcome in our case series.http://www.ijo.in/article.asp?issn=0301-4738;year=2020;volume=68;issue=1;spage=170;epage=173;aulast=Agashea-pattern exotropiadissociated vertical deviationinferior oblique anteropositioningsuperior oblique over actionsuperior oblique tenectomy |
| spellingShingle | Prachi Agashe Ashish Doshi Surgical management of Helveston syndrome (triad of A- pattern exotropia, superior oblique overaction and dissociated vertical deviation) using 'Four Oblique' procedure Indian Journal of Ophthalmology a-pattern exotropia dissociated vertical deviation inferior oblique anteropositioning superior oblique over action superior oblique tenectomy |
| title | Surgical management of Helveston syndrome (triad of A- pattern exotropia, superior oblique overaction and dissociated vertical deviation) using 'Four Oblique' procedure |
| title_full | Surgical management of Helveston syndrome (triad of A- pattern exotropia, superior oblique overaction and dissociated vertical deviation) using 'Four Oblique' procedure |
| title_fullStr | Surgical management of Helveston syndrome (triad of A- pattern exotropia, superior oblique overaction and dissociated vertical deviation) using 'Four Oblique' procedure |
| title_full_unstemmed | Surgical management of Helveston syndrome (triad of A- pattern exotropia, superior oblique overaction and dissociated vertical deviation) using 'Four Oblique' procedure |
| title_short | Surgical management of Helveston syndrome (triad of A- pattern exotropia, superior oblique overaction and dissociated vertical deviation) using 'Four Oblique' procedure |
| title_sort | surgical management of helveston syndrome triad of a pattern exotropia superior oblique overaction and dissociated vertical deviation using four oblique procedure |
| topic | a-pattern exotropia dissociated vertical deviation inferior oblique anteropositioning superior oblique over action superior oblique tenectomy |
| url | http://www.ijo.in/article.asp?issn=0301-4738;year=2020;volume=68;issue=1;spage=170;epage=173;aulast=Agashe |
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