Reply

Abstract

We thank the authors for their interest in our article and welcome their comments. We are very much aware that inferior oblique overaction (IOOA) is commonly associated with esotropia and, hence, the classification into primary and secondary groups. In the primary IOOA group (associated with horizontal strabismus), 36 of the 46 had horizontal strabismus (31 in the myectomy group and 5 in the anterior transposition group). In the secondary IOOA group, none had horizontal strabismus. The possible selection bias the authors have rightly brought up was highlighted in our article (p. 604, final paragraph). Although the operations were conducted by more than one surgeon, all operations were supervised by a single surgeon (John A. Bradbury), and a standard technique described in the methods section was used. Furthermore, this makes the results not surgeon specific and thus more generalizable—and more relevant. Clinical significance of the improvement in superior oblique underaction is subject to observer interpretation and can be very relative (improvements in appearance or improvements in symptoms due to underaction or improvements in the resultant sequelae of overaction of ipsilateral antagonist etc). It is up to the readers to interpret the results of this study and plan what is best for their patients. The results described in our study are 6-month postoperative outcomes. Finally, we agree with the authors that a prospective randomized comparative study with subjects matched for the preoperative deviation is necessary. We hope this study will form a basis to plan such a trial. Myectomy versus anterior transposition for inferior oblique overactionJournal of American Association for Pediatric Ophthalmology and Strabismus {JAAPOS}Vol. 12Issue 4PreviewWe read with great interest Ghazawy et al's1 retrospective review of 120 eyes of 81 patients who underwent inferior oblique myectomy or anterior transposition and the effect of this surgery on improving inferior oblique muscle overaction and superior oblique muscle underaction in eyes with primary or secondary inferior oblique muscle overaction during a period of 5 years (2000-2006). We commend the authors for their effort; however we would like to offer a few comments on certain aspects of their study. Full-Text PDF