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Cochrane Database of Systematic Reviews

Intervenciones quirúrgicas para el estrabismo vertical en la parálisis del músculo oblicuo superior

Información

DOI:
https://doi.org/10.1002/14651858.CD012447.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 27 noviembre 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Salud ocular y de la visión

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

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Contraer

Autores

  • Melinda Y Chang

    Correspondencia a: Stein Eye Institute, UCLA, Los Angeles, USA

    [email protected]

  • Anne L Coleman

    Stein Eye Institute, UCLA, Los Angeles, USA

  • Victoria L Tseng

    Stein Eye Institute, UCLA, Los Angeles, USA

  • Joseph L Demer

    Ophthalmology, Stein Eye Institute, UCLA, Los Angeles, USA

Contributions of authors

Review co‐ordination: MYC

Data collection

  • Designing search strategies: MYC, Iris Gordon (CEV Information Specialist)

  • Undertaking searches: Iris Gordon

  • Screening search results: MYC, VLT

  • Organizing retrieval of papers: MYC

  • Screening retrieved reports against inclusion criteria: MYC, VLT

  • Appraising risk of bias: MYC, VLT

  • Extracting data: MYC, VLT

  • Obtaining and screening data on unpublished studies: MYC, VLT

Data management for the review

  • Entering and verifying data in Review Manager 5: MYC, VLT

  • Analyzing data: MYC, VLT

Interpretation of data

  • Providing a methodological perspective: MYC, ALC, VLT, JLD

  • Providing a clinical perspective: MYC, ALC, VLT, JLD

  • Providing a policy perspective: MYC, ALC, VLT, JLD

  • Providing a consumer perspective: MYC, ALC, VLT, JLD

Writing the review: MYC, ALC, VLT, JLD
Providing general advice on the review: MYC, ALC, VLT, JLD
Securing funding for the review: JLD
Performing previous work that was the foundation of the current study: JLD
Guarantor for review: MYC

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • Methodological support provided by the Cochrane Eyes and Vision (CEV) US Project, supported by grant 1 UG1 EY020522, National Eye Institute, National Institutes of Health, USA.

  • National Institute for Health Research (NIHR), UK.

    • Richard Wormald, Co‐ordinating Editor for CEV, acknowledges financial support for his CEV research sessions from the Department of Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology.

    • This review was supported by the NIHR, via Cochrane Infrastructure funding to the CEV UK editorial base.

    The views expressed in this publication are those of the authors and not necessarily those of the NIHR, National Health Service (NHS), or the Department of Health.

Declarations of interest

MYC: receives support from an Unrestricted Grant from Research to Prevent Blindness, Inc., to the Department of Ophthalmology at the University of California, Los Angeles.
ALC: receives honoraria from Allergan and Reichert, Inc. (Irvine, California, USA); receives support from an Unrestricted Grant from Research to Prevent Blindness, Inc., to the Department of Ophthalmology at the University of California, Los Angeles.
VLT: receives support from an Unrestricted Grant from Research to Prevent Blindness, Inc., to the Department of Ophthalmology at University of California, Los Angeles.
JLD: receives support from US National Eye Institute Grant EY008313; receives support from an Unrestricted Grant from Research to Prevent Blindness, Inc., to the Department of Ophthalmology at the University of California, Los Angeles.

Acknowledgements

Iris Gordon, Information Specialist for Cochrane Eyes and Vision (CEV), developed and executed the electronic search strategies. We thank John Sloper, Barbara Hawkins, and Sarah Hatt for commenting on the protocol.

Version history

Published

Title

Stage

Authors

Version

2017 Nov 27

Surgical interventions for vertical strabismus in superior oblique palsy

Review

Melinda Y Chang, Anne L Coleman, Victoria L Tseng, Joseph L Demer

https://doi.org/10.1002/14651858.CD012447.pub2

2016 Dec 05

Surgical interventions for vertical strabismus in superior oblique palsy

Protocol

Melinda Y Chang, Anne L Coleman, Victoria L Tseng, Joseph L Demer

https://doi.org/10.1002/14651858.CD012447

Differences between protocol and review

After publication of the protocol (Chang 2016), we modified the outcomes to include the proportion of participants with relief of symptoms. As patients may seek treatment due to symptomatic diplopia and because some patients may still be symptomatic even when meeting objective criterion for surgical success, we added this outcome to assess the patient's experience following surgery.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adult; Child; Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Summary of findings for the main comparison. Inferior oblique myectomy versus recession for vertical strabismus in superior oblique palsy

Inferior oblique myectomy compared with inferior oblique recession for vertical strabismus in superior oblique palsy

Patient or population: people with symptom‐producing and/or socially noticeable unilateral overacting inferior oblique muscle; all participants had longstanding unilateral superior oblique underaction

Settings: eye hospital

Intervention: inferior oblique myectomy

Comparison: inferior oblique recession

Outcomes

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Proportion of participants with postoperative surgical success (hypertropia less than 3 PD in primary gaze)

N/A

23 (1 study)

N/A

This outcome measure was not reported in the study included in this comparison. However, median hypertropia in primary gaze at 12 months was 3 PD in the myectomy group and 1 PD in the recession group. The average reduction in hypertropia in primary position was 14 PD in the myectomy group and 8 PD in the recession group (P = 0.042).

Proportion of participants with anomalous head position preoperatively with residual head tilt postoperatively

N/A

23 (1 study)

N/A

This outcome measure was not reported in the study included in this comparison.

Proportion of participants with postoperative hypertropia less than 3 PD in down gaze

N/A

23 (1 study)

N/A

This outcome measure was not reported in the study included in this comparison.

Proportion of participants with postoperative hypertropia less than 3 PD in contralateral gaze

N/A

23 (1 study)

N/A

This outcome measure was not reported in the study included in this comparison.

Proportion of participants who received additional strabismus surgery

N/A

23 (1 study)

N/A

None of the participants in either group required a second strabismus surgery during the follow‐up interval.

Proportion of participants with reversal of vertical deviation postoperatively

N/A

23 (1 study)

N/A

This outcome measure was not reported in the study included in this comparison.

Proportion of participants with postoperative orbital cellulitis

N/A

23 (1 study)

N/A

This outcome measure was not reported in the study included in this comparison.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of the effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of the effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of the effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

CI: confidence interval; N/A: not applicable; PD: prism diopters

Figuras y tablas -
Summary of findings for the main comparison. Inferior oblique myectomy versus recession for vertical strabismus in superior oblique palsy
Ir a la tabla de la revisión
Summary of findings 2. Inferior oblique disinsertion versus anterior transposition for vertical strabismus in superior oblique palsy

Inferior oblique disinsertion compared with inferior oblique anterior transposition for vertical strabismus in superior oblique palsy

Patient or population: people with unilateral superior oblique palsy

Settings: eye hospital

Intervention: inferior oblique disinsertion

Comparison: inferior oblique anterior transposition

Outcomes

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Proportion of participants with postoperative surgical success (hypertropia less than 3 PD in primary gaze)

N/A

22 (1 study)

Moderate

This outcome measure was not reported in the study included in this comparison. However, the mean reduction of hypertropia in primary position was 13.3 (SD 1.9) PD in the disinsertion group and 18.5 (SD 3.9) PD in the anterior transposition group (mean difference ‐5.20 PD, 95% CI ‐7.76 to ‐2.64). This difference favors inferior oblique anterior transposition.

Proportion of participants with anomalous head position preoperatively with residual head tilt postoperatively

RR 7.00 (0.40 to 121.39)

22 (1 study)

Very low

This outcome favors inferior oblique anterior transposition.

Proportion of participants with postoperative hypertropia less than 3 PD in down gaze

N/A

22 (1 study)

N/A

This outcome measure was not reported in the study included in this comparison.

Proportion of participants with postoperative hypertropia less than 3 PD in contralateral gaze

N/A

22 (1 study)

Moderate

The mean reduction of hypertropia in adduction was 20.6 (SD 6.2) PD in the disinsertion group and 27.7 (SD 9.6) PD in the anterior transposition group (mean difference ‐7.10 PD, 95% CI ‐13.85 to ‐0.35). Anterior transposition resulted in a greater decrease in hypertropia in contralateral gaze, but it was unclear whether this difference favored the anterior transposition group, since the authors did not report the number of participants overcorrected in contralateral gaze.

Proportion of participants who received additional strabismus surgery

RR 7.00 (0.40 to 121.39)

22 (1 study)

Very low

This outcome favors inferior oblique anterior transposition.

Proportion of participants with reversal of vertical deviation postoperatively

N/A

22 (1 study)

N/A

None of the participants in either group developed postoperative reversal of vertical deviation.

Proportion of participants with postoperative orbital cellulitis

N/A

22 (1 study)

N/A

This outcome measure was not reported in the study included in this comparison.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of the effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of the effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of the effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

CI: confidence interval; N/A: not applicable; PD: prism diopters; RR: risk ratio; SD: standard deviation

Figuras y tablas -
Summary of findings 2. Inferior oblique disinsertion versus anterior transposition for vertical strabismus in superior oblique palsy
Ir a la tabla de la revisión