Fat adherence syndrome: an animal model

Fat adherence syndrome following inferior oblique surgery: Treatment and outcomes

PURPOSE

Describe surgical treatment and results in a group of patients diagnosed and operated on of fat adherence syndrome following inferior oblique surgery.

PATIENTS, MATERIAL AND METHODS

Retrospective study of 6 cases diagnosed and treated of fat adherence syndrome following inferior oblique surgery. Mean age was 24.67 years (range, 5-41), 3 males, 5 unilateral and 1 bilateral. Mean vertical deviation was 16.16pd (range, 4-25). Esotropia was associated in 4 cases, diplopia in other 2, and anomalous head posture in 3. A good outcome was considered when the final deviation was less than 10pd, with mild limitation of elevation, without anomalous head posture, and a negative duction forced test.

RESULTS

The final vertical deviation was 6.83pd (range, 0-14). A 2-4mm inferior rectus recession was performed on 4 patients associated to an inferior oblique surgery/exploration. All patients were operated on once, except 1 case. A good outcome was achieved in 3 patients. Anomalous head posture was resolved in 2 of 3 cases. Diplopia resolved after surgery. Only one case achieved orthophoria. Mean evolution time was 34.83 months (range, 6-78).

CONCLUSION

In the treatment of the fat adherence syndrome, an inferior rectus recession is recommended, associated to inferior oblique exploration or surgery. A good favorable outcome was only achieved in half of the cases with surgical treatment. Limitation of elevation could not be completely resolved in any of the patients.

Vertical diplopia and ptosis from removal of the orbital roof in pterional craniotomy

PURPOSE

To describe a newly recognized clinical syndrome consisting of ptosis, diplopia, vertical gaze limitation, and abduction weakness that can occur after orbital roof removal during orbito-zygomatic-pterional craniotomy.

DESIGN

Case series.

PARTICIPANTS

Eight study patients (7 women), 44 to 80 years of age, with neuro-ophthalmic symptoms after pterional craniotomy.

METHODS

Case description of 8 study patients.

MAIN OUTCOME MEASURES

Presence of ptosis, diplopia, and gaze limitation.

RESULTS

Eight patients had neuro-ophthalmic findings after pterional craniotomy for meningioma removal or aneurysm clipping. The cardinal features were ptosis, limited elevation, and hypotropia. Three patients also had limitation of downgaze and 2 patients had limitation of abduction. Imaging showed loss of the fat layers that normally envelop the superior rectus and levator palpebrae superioris. The muscles appeared attached to the defect in the orbital roof. Ptosis and diplopia developed in 2 patients despite Medpor titanium mesh implants. Deficits in all patients showed spontaneous improvement. In 2 patients, a levator advancement was required to repair ptosis. In 3 patients, an inferior rectus recession using an adjustable suture was performed to treat vertical diplopia. Follow-up a mean of 6.5 years later revealed that all patients had a slight residual upgaze deficit, but alignment was orthotropic in primary gaze.

CONCLUSIONS

After pterional craniotomy, ptosis, diplopia, and vertical gaze limitation can result from tethering of the superior rectus-levator palpebrae superioris complex to the surgical defect in the orbital roof. Lateral rectus function sometimes is compromised by muscle attachment to the lateral orbital osteotomy. This syndrome occurs in approximately 1% of patients after removal of the orbital roof and can be treated, if necessary, by prism glasses or surgery.

A pilot study of the value of prism adaptation in planning strabismus reoperations

PURPOSE

To evaluate the value of prism adaptation in planning strabismus reoperations.

METHODS

Of 15 patients with persistent strabismus, 9 underwent prism adaptation prior to strabismus reoperation and 6 underwent strabismus reoperation without preoperative prism adaptation. Corrective surgery was performed on the same or new muscles. Follow-up ranged from 3 months to 2 years. A horizontal deviation of 10 prism diopters or less was considered a successful outcome. Statistical analysis of the results was done.

RESULTS

Of the 9 patients who had prism adaptation, 3 (33%) were responders and 6 (67%) were nonresponders. A successful outcome was achieved in 6 patients (67%) who had prism adaptation and 3 patients (50%) who did not. The difference between groups was statistically insignificant (P > .05).

CONCLUSION

These results suggest that the benefits of prism adaptation are not significant enough to justify the time consumption and expenses of this test when planning strabismus reoperations, but a larger group of patients should be studied.