Surgical treatment of upgaze palsy in Parinaud's syndrome

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
Edward G Buckley, Sandra Holgado

Abstract

Upgaze paralysis due to supranuclear defects can cause significant visual symptoms. There are only a few reports on the treatment of this problem in the literature. Patients with Parinaud's syndrome may also have retraction nystagmus and convergence on attempted upgaze that further complicates the treatment. We performed a retrospective review of 48 patients with Parinaud's syndrome. Eleven patients were not able to elevate to the primary position and underwent surgery for the upgaze defect. Surgical treatments included transpositions in 2 patients, inferior rectus recessions in 8, which was combined with a superior rectus resection in one. Preoperative duction measurements demonstrated an average limitation on upgaze to -19 degrees (-10 to -30) below midline with zero representing midline. Postoperative measurements showed marked improvement to +19 degrees above midline (15 to 30). Inferior rectus recessions were as effective as transpositions in restoring function. In addition, there was a marked reduction in the retraction nystagmus and upgaze convergence as well. Visually significant upgaze limitation can be relieved with bilateral inferior rectus recessions in Parinaud's syndrome. Retraction nystagmus and convergence movem...Continue Reading

Citations

Nov 11, 2011·The American Orthoptic Journal·Michael C Brodsky
Feb 5, 2015·International Ophthalmology·Josefina SerinoIsabel Ribeiro
Oct 26, 2016·Acta Ophthalmologica·Melissa ShieldsJohn Crompton
Oct 22, 2013·The American Orthoptic Journal·G Robert LaRoche
Feb 22, 2014·ISRN Ophthalmology·Fiona J RoweCicely Freeman
Nov 18, 2014·Current Treatment Options in Neurology·Ruben Torres-Torres, Bernardo F Sanchez-Dalmau

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