Turkiye Klinikleri Journal of Ophthalmology

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Edinsel İzole Troklear (IV.) Sinir Paralizilerinde Başlangıç Klinik Bulguların ve Etiyolojik Faktörlerin Spontan Düzelme ile İlişki
Initial Clinical Findings and Etiological Factors of Acquired Isolated Trochlear (IV.) Nerve Palsy and Their Relationship with Spontaneous Recovery
Aslı KIRMACIa, Osman Bulut OCAKa, Aslı İNALa, Beril TÜLÜ AYGÜNa, Ebru Demet AYGITa, Selcen ÇELİKa, Ceren GÜREZa, Zahid HÜSEYİNHANa, Muhittin TAŞKAPILIa, Birsen GÖKYİĞİTa
aGöz Hastalıkları Kliniği, İstanbul Prof. Dr. N. Reşat Belger Beyoğlu Göz Eğitim ve Araştırma Hastanesi, İstanbul, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2019;28(3):148-53
doi: 10.5336/ophthal.2018-63518
Article Language: TR
Full Text
ÖZET
 Amaç: Edinsel izole troklear sinir paralizilerinde, etiyoloji ve klinik bulgular ile spontan düzelme arasındaki ilişkinin değerlendirilmesidir. Gereç ve Yöntemler: 2012-2017 yılları arasında kliniğimize başvuran ve edinsel izole troklear sinir paralizi tanısı alan hastalar retrospektif olarak tarandı. Takip süresi altı aydan fazla olanlar çalışma kapsamına alındı. Hastaların epidemiyolojik özellikleri, klinik bulguları ve etiyolojileri kayıt altına alındı. Hastalar, spontan düzelenler (Grup 1) ve düzelme gözlenmeyip, cerrahi önerilenler (Grup 2) olarak iki gruba ayrıldı. Bu iki grup, klinik bulgular ve etiyoloji açısından istatistiksel olarak karşılaştırıldı. Bulgular: Kırk dokuz (32 erkek, 17 kadın) hasta çalışma kapsamına alındı. Hastaların yaş ortalaması 39,82±21,03 yıl idi. Hastalardaki ortalama başlangıç vertikal kayma ölçüm değerleri uzakta 9,63±6,30 prizma dioptrisi (PD) ve yakında 9,84±6,03 PD olarak saptandı. Oküler motilite açısından değerlendirildiğinde, üst oblik kısıtlılığı ortalama -1,83±0,82, alt oblik hiperfonksiyonu ortalama 2,73±1,73 olarak bulundu. Etiyolojide, en sık olarak 19 (%38,78)'unda travma ve 19 (%38,78)'unda mikrovasküler patoloji saptandı. Hastaların 29'unda spontan düzelme (Grup 1) saptanır iken, 20'sinde spontan düzelme görülmedi (Grup 2). Grup 1'de ortalama vertikal kayma değerleri 7,21±4,44 PD iken, Grup 2'de ise 13,15±7,02 PD olarak bulundu. Grup 1 ve grup 2 arasında, vertikal kayma ölçüm değerleri açısından istatistiksel olarak anlamlı fark belirlendi. Üst oblik kısıtlılığı ve alt oblik hiperfonksiyonu değerleri arasında istatistiksel olarak anlamlı fark bulunmadı. Sonuç: Edinsel izole troklear sinir paralizilerinde, başvuru sırasındaki uzak ve yakın vertikal kayma ölçüm değerlerinin, düzelme gözlenmeyen hastalarda daha yüksek olduğu sonucuna varılmıştır.

Anahtar Kelimeler: Dördüncü kranyal sinir paralizi; troklear sinir felci; edinsel; etiyoloji; spontan düzelme
ABSTRACT
 Objective: Determining clinical findings and etiological factors of acquired isolated trochlear nerve palsy and evaluating their relationship with spontaneous recovery. Material and Methods: Records of the patients diagnosed with acquired isolated trochlear nerve palsy in our hospital between 2012-2017 were reviewed. Patients with a follow-up period of more than 6 months were included in this study. The epidemiological and clinical findings, and the etiologies were noted. The patients were divided into two groups: patients with spontaneous recovery (Group 1), and patients who did not have spontaneous recovery and underwent surgery (Group 2). Statistical evaluation was performed between these two groups. Results: Forty nine cases (32 male, 17 female) were included in this study. Mean age was 39.82±21.03 years. The mean angle of vertical deviation was 9.63±6.30 prism diopter (PD) for distance and 9,84±6,03 PD for near. The mean superior oblique underaction was -1.83±0.82, and the mean inferior oblique overaction was 2.73±1.73. Trauma (38.78%) and microvascular pathologies (38.78%) were the most frequent etiologies. Spontaneous recovery was observed in 29 patients (Group 1), and 20 patients did not have spontaneous recovery (Group 2). The mean initial angle of vertical deviation was 7.21±4.44 PD in group 1, and 13.15±7.02 PD in group 2. There was a statistical significance in terms of initial angles of vertical deviation, between group 1 and group 2. No statistical significance was found in terms of superior oblique underaction and inferior oblique overaction. Conclusion: In acquired isolated trochlear nerve palsy, initial angles of vertical deviation for distance and for near were found to be higher in cases without spontaneous recovery.

Keywords: Fourth cranial nerve palsy; trochlear nerve palsy; acquired; etiology; spontaneous recovery
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