Journal of American Association for Pediatric Ophthalmology and Strabismus
Major articleSurgical treatment of upgaze palsy in Parinaud's syndrome
Section snippets
Patients and methods
After appropriate Institutional Review Board approval, a retrospective chart review identified 48 patients with Parinaud's syndrome seen between 1985 and 2000. All patients had upgaze defects, retraction nystagmus, and pupillary abnormalities of varying degree. Eleven of the 48 underwent surgery for upgaze defect requiring a chin-up head position, in combination with severe retraction nystagmus and convergence spasm on attempted upgaze. Those patients who had follow-up of at least one year
Results
A summary of the preoperative and postoperative measurements of vertical eye movements is shown in Table 2. Preoperatively the average amount of maximum vertical movement was only to 11.9° below midline. Downgaze movement was considered normal averaging almost 48°. After surgery the average movement upward improved to 19.4° degrees above midline with a range of 10° to 30° (P = .0003). Postoperative downgaze rotations were affected with an average reduction in downward movement of 13° (P =
Discussion
There are only isolated case reports in the literature on the treatment of the upgaze disorder associated with Parinaud's syndrome.5, 6 Surgical treatment options are limited and consist of either weakening the inferior rectus, enhancing elevation force by resecting the superior rectus, or creating an alternative force by superiorly transposing the medial and lateral rectus muscles. In the previous reports, patients underwent bilateral superior rectus resection5 and bilateral inferior rectus
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