Journal of American Association for Pediatric Ophthalmology and Strabismus
Major articleLong-term outcomes after surgical management of chronic sixth nerve palsy*,**
Section snippets
Cohort
As we have described previously,1, 6, 7 we used a prospective multicenter data collection study design. All members of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and the North American Neuro-Ophthalmology Society (NANOS) were invited to enroll patients with chronic sixth nerve palsy during a 2-year period (between March 1998 and February 2000). Inclusion criteria were chosen to parallel those that might be used for a future randomized treatment trial (Table 1).
Description of the cohort
Thirty-one patients with chronic sixth nerve palsy who underwent surgical intervention were enrolled in 18 centers (see acknowledgements). Ages ranged from 5 years to 83 years (median, 45 years); 55% were female and 90% were white (Table 2).Regarding etiology of the chronic sixth nerve palsy, 14 (45%) were traumatic, 9 (29%) were unknown (including presumed hypertensive), 4 (13%) were neoplastic, and 4 (13%) were other (Table 2). The other causes included 1 case of aneurysm, 1 described as
Discussion
In this prospective multicenter study of chronic sixth nerve palsy or paresis, the long-term surgical success rate was 52% using strict criteria for success and 75% if partial success with small angle strabismus is included. A total of 32% of all patients had a second procedure and 19% were using prism.
The long-term overall success rate of 75% with surgery for chronic sixth nerve palsy is clearly greater than in our first report1 of initial surgical outcome. Our long-term success rate is
Acknowledgements
The authors thank the following investigators for their participation in this study: Brian Arthur, MD, Wilkes-Barre, Pa; William Astle, MD, Calgary, Alberta, Canada; Sandra Brown, MD, Lubbock, Tex; Stephen Christiansen, MD, Minneapolis, Minn; David Coats, MD, Houston, Tex; Oscar Cruz, MD, St Louis, Mo; Sean Donahue, MD, PhD, Nashville, Tenn; Mark Dorfman, MD, Hollywood, Fla; Patrick Droste, MD, Grand Rapids, Mich; W. Keith Engel, MD, Minneapolis, Minn; Robert Enzenauer, MD, MPH, Chattanooga,
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Cited by (29)
Surgical outcomes following strabismus surgery for abducens nerve palsy
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2021, Journal Francais d'OphtalmologieHypertropia in unilateral isolated abducens palsy
2014, Journal of AAPOSCitation Excerpt :Of 28 cases attributed to microvascular disease, 16 (57%) exhibited hypertropia. The present study confirms and extends findings of smaller, earlier studies reporting that hypertropia is commonly associated with isolated, unilateral abducens nerve palsy.3-5 Etiology of this hypertropia has been controversial but has been hypothesized to include trochlear palsy, skew deviation, and physiologic hyperphoria unmasked by horizontal strabismus.
Long-term results of vertical rectus muscle transposition and botulinum toxin for sixth nerve palsy
2010, Journal of AAPOSCitation Excerpt :In 1997 Foster5 described augmentation of the vertical rectus muscle transposition using posterior fixation sutures in each of the transposed muscles. He reported a reduction in esotropia that was comparable to a nonaugmented transposition combined with botulinum toxin injection.4,14,15 In our study, using a full-tendon transposition and botulinum toxin injection to the ipsilateral medial rectus muscle, 59% of patients with chronic sixth nerve palsy were aligned within 10Δ of deviation in the primary position after a mean follow-up of 44.2 months.
Differential diagnosis and management of acquired sixth cranial nerve palsy
2006, OptometryCitation Excerpt :Surgery should be considered when the deviation has been stable for at least 6 months.7 More than 1 surgical treatment or the use of prism after surgery is often necessary.19 Approximately half of all CN VI palsies recover spontaneously approximately 3 months after onset.2,3,5,10
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Supported by National Institutes of Health grant EY11578; Research to Prevent Blindness, Inc (J.M.H. as Olga Keith Wiess Scholar and an unrestricted grant to the Mayo Clinic Department of Ophthalmology), New York, New York; and the Mayo Foundation, Rochester, Minnesota.
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Reprint requests: Dr Jonathan M. Holmes, Department of Ophthalmology W7, Mayo Clinic, Rochester, MN 55905.