Strabismus Surgery Outcomes in Patients with Medial Longitudinal Fasciculus Syndrome

• Published in: Neuro-Ophthalmology Japan Vol. 41; no. 3; pp. 213 - 219
• Main Authors: Kondo, Miho, Kimura, Akiko, Igarashi, Masahide, Masuda, Akiko, Mochizuki, Yoshihito, Gomi, Fumi
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Neuro-Ophthalmology Society 25.09.2024; 日本神経眼科学会
• Subjects: extraocular muscle surgery; MLF syndrome; paralytic exotropia
• ISSN: 0289-7024; 2188-2002
• DOI: 10.11476/shinkeiganka.41.213

This retrospective study included 9 patients (6 men and 3 women, mean age 57.1±17.1 years) with paralytic exotropia secondary to medial longitudinal fasciculus (MLF) syndrome who underwent extraocular muscle surgery at our department. We obtained data regarding background, surgical procedures, and treatment outcomes. MLF syndrome was associated with cerebrovascular disease in 3, head injury in 2, brain tumor in 2, and multiple sclerosis in 2 patients. Treatment was aimed at management of diplopia in 5 of 9 patients, cosmetic improvement in 3 patients, and improvement of abnormal head posture in 1 patient. Horizontal strabismus alone was observed in 1 patient, and the remaining 8 patients had combined vertical and cyclodeviation. Except in one patient, all patients underwent large recession of the lateral rectus (LR) muscle of the affected eye combined with resection of the medial rectus and inferior oblique muscle or superior / inferior rectus muscle surgery for vertical deviation correction.　Diplopia resolved postoperatively in three of five patients. Of the two patients with residual diplopia, one underwent reoperation; however, diplopia persisted. In both patients, vertical deviation was corrected using prism glasses, with disappearance of diplopia. Treatment was unsuccessful in one of 3 patients with cosmetic concerns and in one patient with abnormal head posture. Large recession of the LR in the affected eye is essential to improve paralytic exotropia that occurs in MLF syndrome. Although the first surgery was unsuccessful, the operation was successful in seven of nine patients, and strabismus associated with MLF syndrome can be considered an aggressive treatment target.