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Abstract
Objectives To summarize the clinical manifestations, diagnosis, treatment, and prognosis for inferior oblique muscle ectopia (IO-E). Subjects and Methods. Patients diagnosed with IO-E during strabismus surgery from March 2017 to September 2018 were included in this retrospective, cross-sectional study. All patients received preoperative Krimsky test, synoptophore, cycloplegia refraction, fundus torsion, and other strabismus-related specific tests. The anatomic variations of IO-E were always discovered during surgical procedure. Postoperative eye position and binocular visual function (BVF) were all reviewed in early days after operation. Results A total of 7 patients were enrolled in this study with an average age of 6.4 ± 3.8 yrs. They all presented with significant exotropia and unilateral (or bilateral) overelevation in adduction (OEA). No compensatory head position was detected. Some of them had vertical deviation, V pattern, or excyclotropia, which were indicated by fundus torsion. Monocular or binocular IO-E was distinguished during the surgery, and it could be classified into two types according to its anatomic features. In surgery, the ectopic IO muscle bundle was restored, and different IO weakening methods were employed. Meanwhile, the horizontal deviation was also corrected according to the preoperative examination. Eyes of all patients were properly aligned in the primary position after surgery. Varying degrees of BVF appeared in 3 cases. Conclusions IO-E is a rare congenital dysplasia variation of the extraocular muscle, which could appear as inferior oblique overaction. It is difficult to diagnose before surgery, and weakening the overactive ectopic inferior oblique was required for better prognosis if this condition was confirmed during surgery.
Highlights
Anatomical abnormalities of the inferior oblique (IO) are quite rare in clinical practice; the accurate diagnosis and proper management could determine the prognosis of surgery. ere were only a few case reports about inferior oblique ectopia (IO-E) so far
By retrospectively reviewing the anatomical structure, clinical features, surgery design, and prognosis of IO-E, our study provided a reference for surgery design when encountered with IO-E
IO-E is a rare congenital dysplasia, which is supposed to be derived from developmental abnormalities of the extraocular muscles during the embryonic period. ere is currently no special preoperative examination to predict whether a patient has IO-E
Summary
Anatomical abnormalities of the inferior oblique (IO) are quite rare in clinical practice; the accurate diagnosis and proper management could determine the prognosis of surgery. ere were only a few case reports about inferior oblique ectopia (IO-E) so far. Anatomical abnormalities of the inferior oblique (IO) are quite rare in clinical practice; the accurate diagnosis and proper management could determine the prognosis of surgery. Ere were only a few case reports about inferior oblique ectopia (IO-E) so far. Wang Xiaojun reported a case in which the insertion of the IO tendon into the sclera displaced retroposed [1]. Huiqin and Guan found one case in which the IO attached to the sclera backwardly, and the muscle structure was abnormal [3]. We conducted a retrospective analysis of the IO-E cases we encountered in the past two years in order to shed light on the diagnosis and treatment for this rare disease
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