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  • Title: Modified Harada-Ito procedure in bilateral superior oblique paresis.
    Author: Roberts C, Dawson E, Lee J.
    Journal: Strabismus; 2002 Sep; 10(3):211-4. PubMed ID: 12461715.
    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.
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