Harada - Ito and Fells techniques for torsional diplopia treatment of superior oblique paresis

Abstract

Background and purpose: To describe the results of isolated Harada-Ito or Fells modification surgery in the treatment of diplopia, torticollis and excyclotorsion secondary to superior oblique paresis (SOP).

Material and methods: Retrospective workup of subjects operated on since 2015-November 2024. The age, sex, etiology of SOP, preoperative and immediate and late postoperative excyclotorsion, pre- and postoperative vertical deviation and torticollis, as well as type of suture (resorbable or not) were collected. The time of evolution of the SOP and follow-up from surgery to data collection were recorded. The resolution or improvement of diplopia, excyclotorsion and torticollis were considered a good outcome.

Results: Eight cases were operated on (4 women). In six, the left eye, bilateral (1). The etiology of the SOP was neoplasia (2), trauma (1), ischemic (3), infectious (1), idiopathic (1). All had subjective excyclotorsion (between 5º-15º) that disappeared at the end of follow-up. The mean torsion correction was 7.87º ± 2.47º, with resorbable suture 7º ± 2.44º and non-resorbable 8.75 º ± 2.5º. Torticollis was observed before surgery in all 8 patients, which resolved after surgery except in one case. Preoperative vertical deviation ranged from a minimum of 2 pd to a maximum of 8 pd, resolving in seven cases. The preoperative diplopia resolved in 4 of the 8 cases and improved in the rest.

Conclusions: Harada-Ito surgery and Fells modification resolved or improved diplopia, symptomatic excyclotorsion and torticollis in patients diagnosed with SOP. No resorbable suture had a greater effect on extortion correction (not statistically significant) at the end of follow-up.

Keywords: Diplopía torsional; Harada-Ito technique (Fells modification); Non-resorbable suture; Paresia oblicuo superior; Superior oblique paresis; Sutura no reabsorbible; Torsional diplopia; Torticollis; Tortícolis; Técnica de Harada-Ito (modificación de Fells).