Outcomes of Strabismus Surgery in Patients with Cranial Nerve Palsy
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Baseline Characteristics
3.2. Change in Angle of Deviation
3.3. Change in Vertical Deviation
3.4. Change in Refractive Error
3.5. Change in Visual Acuity
3.6. Additional Operations
3.7. Multivariable Logistic Regression
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AOD | Angle of deviation |
BCVA | Best-corrected visual acuity |
CN3 | Third cranial nerve |
CN4 | Fourth cranial nerve |
CN6 | Sixth cranial nerve |
D | Diopters |
IO | Inferior oblique |
IQR | Interquartile range |
LL | Lower limit |
logMAR | logarithm of the minimal angle of resolution |
LR | Lateral rectus |
MR | Medial rectus |
OR | Odds ratio |
PD | Prism diopters |
SD | Standard deviation |
SO | Super oblique |
UL | Upper limit |
VA | Visual acuity |
VD | Vertical deviation |
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Etiologies | CN3 Palsy (n = 12) | CN4 Palsy (n = 8) | CN6 Palsy (n = 30) | Combined Palsy (n = 7) | |
---|---|---|---|---|---|
Congenital | 0 | 2 | 0 | 0 | |
Acquired | Inflammation | 0 | 0 | 1 | 0 |
Trauma | 3 | 4 | 5 | 1 | |
Brain neoplasm | 4 | 1 | 12 | 2 | |
Vascular disease | 4 | 0 | 6 | 4 | |
Unknown | 1 | 1 | 6 | 0 |
Surgical Procedure | CN3 Palsy (n = 12) | CN4 Palsy (n = 8) | CN6 Palsy (n = 30) | Combined Palsy (n = 7) |
---|---|---|---|---|
MR recession & LR plication | 20 | 1 | ||
LR recession & MR plication | 9 | 1 | ||
Horizontal 2-muscle surgery with oblique muscle procedure | 2 | 1 | ||
MR recession | 1 | |||
LR plication | 5 | 2 | ||
LR recession with oblique muscle recession | 1 | |||
LR plication with oblique muscle plication | 2 | |||
IO recession | 5 | |||
SO plication | 3 | 1 | ||
Hummelsheim procedure | 3 |
Type of Strabismus | Preoperative AOD (°) | MR Recession/Plication * (mm) | LR Recession/Plication * (mm) |
---|---|---|---|
CN3 palsy | 10 | 5.5 | 8 |
15 | 5.5 | 9 | |
20 | 6 | 8 | |
50 | 6 | 12 | |
CN4 palsy | 2–14 VD | IO Recession: 11–13 mm with additional anteriorization (1–2 mm) | |
CN6 palsy | 5 | 4.5 | 9.5 |
15 | 3 | 7 | |
20 | 4 | 8.5 | |
30 | 5 | 10 |
CN3 Palsy (n = 12) | CN4 Palsy (n = 8) | CN6 Palsy (n = 30) | Combined Palsy (n = 7) | |
---|---|---|---|---|
Demographic factors | ||||
Age at time of surgery (years) | 39.36 ± 27.65 | 32.21 ± 21.49 | 43.27 ± 22.38 | 46.49 ± 21.62 |
Gender | ||||
Male | 7 (58.33%) | 5 (62.5%) | 16 (53.33%) | 2 (28.57%) |
Female | 5 (41.67%) | 3 (37.5%) | 14 (46.67%) | 5 (71.43%) |
Clinical characteristics | ||||
Type of palsy | ||||
Partial | 3 (25%) | 0 (0%) | 1 (3.33%) | 1 (14.29%) |
Complete | 9 (75%) | 8 (100%) | 29 (96.67%) | 3 (42.86%) |
Both * | 3 (42.86%) | |||
Preoperative AOD (°) | ||||
Near | 23.48 ± 14.7 | 3.24 ± 2.22 | 18.5 ± 8.25 | 13.89 ± 7.57 |
Distance | 20.93 ± 14.24 | 3.62 ± 2.7 | 18.48 ± 7.19 | 15.77 ± 7.03 |
Postoperative AOD at first follow-up (°) | ||||
Near | 11.5 ± 12.8 | 2.86 ± 2.49 | 4.73 ± 4.74 | 9.43 ± 8.44 |
Distance | 10.57 ± 14.72 | 2 ± 2.02 | 4.35 ± 4.29 | 6.86 ± 5.77 |
Postoperative AOD at second follow-up (°) | ||||
Near | 13.44 ± 15.61 | 1.71 ± 1.23 | 5.52 ± 5.12 | 7.54 ± 5.53 |
Distance | 12.14 ± 17.15 | 1.43 ± 0.4 | 5.97 ± 4.47 | 7.71 ± 7.94 |
Preoperative refractive error (D) | 0.19 ± 1.99 | −0.97 ± 1.4 | −0.75 ± 2.94 | 0.27 ± 1.01 |
Preoperative VA (logMAR (IQR)) | 0.09 (0.43) | 0.0 (0.07) | 0.08 (0.15) | 0.05 (0.18) |
Preoperative Ptosis | 9 (75%) | - | - | 1 (14.29%) |
Preoperative Diplopia | 8 (66.67%) | 6 (75.00%) | 12 (40%) | 4 (57.14%) |
Preoperative head tilt | 2 (16.66%) | 4 (50%) | 4 (13.33%) | - |
Surgical success | 7 (58.33%) | 7 (87.5%) | 27 (90%) | 5 (71.43%) |
Failure | 5 (41.67%) | 1 (12.5%) | 3 (10%) | 2 (28.57%) |
Parameters | p-Value | OR | 95% LL | 95% UL | |
---|---|---|---|---|---|
Age | 0.314 | 1.019 | 0.983 | 1.056 | |
Gender | 0.902 | 0.894 | 0.150 | 5.322 | |
Preoperative AOD | 0.149 | 0.912 | 0.804 | 1.034 | |
Type of nerve palsy (with CN6 palsy as reference) | CN3 palsy | 0.061 | 0.143 | 0.019 | 1.097 |
CN4 palsy | 0.201 | 0.093 | 0.002 | 3.535 | |
Combined palsy | 0.123 | 0.138 | 0.011 | 1.708 | |
Etiology (with neoplasm as reference) | Vascular disease | 0.928 | 0.899 | 0.089 | 9.101 |
Trauma | 0.880 | 1.191 | 0.123 | 11.509 | |
Other | 0.628 | 0.545 | 0.047 | 6.345 |
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Hinterhuber, L.; Rezar-Dreindl, S.; Schmidt-Erfurth, U.; Stifter, E. Outcomes of Strabismus Surgery in Patients with Cranial Nerve Palsy. J. Clin. Med. 2025, 14, 7221. https://doi.org/10.3390/jcm14207221
Hinterhuber L, Rezar-Dreindl S, Schmidt-Erfurth U, Stifter E. Outcomes of Strabismus Surgery in Patients with Cranial Nerve Palsy. Journal of Clinical Medicine. 2025; 14(20):7221. https://doi.org/10.3390/jcm14207221
Chicago/Turabian StyleHinterhuber, Laetitia, Sandra Rezar-Dreindl, Ursula Schmidt-Erfurth, and Eva Stifter. 2025. "Outcomes of Strabismus Surgery in Patients with Cranial Nerve Palsy" Journal of Clinical Medicine 14, no. 20: 7221. https://doi.org/10.3390/jcm14207221
APA StyleHinterhuber, L., Rezar-Dreindl, S., Schmidt-Erfurth, U., & Stifter, E. (2025). Outcomes of Strabismus Surgery in Patients with Cranial Nerve Palsy. Journal of Clinical Medicine, 14(20), 7221. https://doi.org/10.3390/jcm14207221