Inferior Oblique Recession Research Articles

Laterality Targeting in Graded Inferior Rectus Tenotomy Corrects Lateral Incomitance of Hypertropia in Sagging Eye Syndrome

PurposeTo determine if laterally selective graded vertical rectus tenotomy (GVRT) of the inferior rectus (IR) can correct the lateral incomitance of hypertropia (HT) commonly encountered in sagging eye syndrome (SES), comparing it with inferior oblique (IO) recession. DesignRetrospective comparative interventional clinical study. MethodsWe reviewed 73 consecutive patients undergoing GVRT of the IR for correction of horizontally incomitant HT due to SES from July 2012 to October 2023. Confounding diagnoses were excluded. Using topical anesthesia, GVRT was initiated from the nasal versus temporal side corresponding to greater HT, with dosing adjusted intraoperatively until cover testing in central gaze indicated orthotropia. We compared 8 cases of IO recession to 4mm posterior and 3mm lateral to the IR insertion. ResultsNasal GVRT was performed in 41 patients (standard deviation), and temporal GVRT on 32 patients. Mean nasal GVRT was 69±15% and mean temporal GVRT was 62±17%. Mean HT in central gaze was reduced by nasal GVRT from 3.9±1.7Δ to 0.3±1.4Δ, and from 4.0±1.6Δ to 0.2±1.1Δ by temporal GVRT. Nasal GVRT corresponding to the side of the tenotomy had greater effect in contralateral gaze at 3.2±2.2Δ than ipsilateral gaze at 2.1±2.0Δ (p=0.0250), whereas temporal GVRT had greater effect in ipsilateral gaze at 4.9±2.7D than contralateral gaze at 2.9±2.9D (p=0.0002). Inferior oblique recession in 8 patients reduced lateral incomitance from 13±5.0Δ to 0.5±1.4Δ (p<0.0001). ConclusionNasal GVRT corrects about 1Δ and temporal GVRT 2Δ horizontal incomitance of HT, while IO recession corrects about 12.5Δ. Selection of GVRT laterality improves outcomes without additional risk or operating time.

The impact of simultaneous correction of the V pattern on the results of surgical treatment in children with intermittent exotropia.

This study is to investigate the impact of the coexistence of basic intermittent exotropia and vertical incomitance in the form of the V and sub-V pattern on the results of surgical correction of intermittent exotropia. The records of 81 pediatric patients who had surgery for intermittent exotropia and a follow-up of more than 1year were reviewed retrospectively. They were divided into groups: a concomitant group which underwent only horizontal muscle surgery of bilateral lateral rectus recession and a V pattern group which had additional inferior oblique recession, further separated into two subgroups: ≥ 15 prism diopters (classic V pattern group) and ≥ 10 < 15 prism diopters (sub-V pattern group). The surgical outcome, deviation control, stereoacuity, and postoperative drift were assessed after 3months and 1year postoperatively. Patients with sub-V and classic V pattern intermittent exotropia showed significantly better surgical success rate (p = 0.025) and less postoperative drift (p = 0.042) than patients without vertical incomitance. One year after surgery, successful surgical outcome was achieved in 83.72% of the vertically incomitant group: 80.76% for the classic V pattern and 88.24% for the sub-V pattern group, while only in 60.53% of nonpattern patients. Patients operated for intermittent exotropia with a coexistent V pattern have consistently better surgical long-term results than those with only horizontal deviation. Additional inferior oblique recessions in the sub V pattern group provided excellent outcomes with no overcorrections; therefore, surgeons should consider addressing vertical incomitance even when the typical criteria for the V pattern are not met.

What to expect from primary inferior oblique overaction after esotropia surgery

BackgroundOverelevation in adduction is common in patients with primary esotropia. This study evaluates the variation in ocular motility pattern in patients with primary inferior oblique (IO) muscle overaction after esotropia surgery.MethodsThe medical records of consecutive patients who underwent surgery for infantile, partially accommodative, and basic esotropia over eleven years and had at least one year of follow-up were reviewed. Patients with primary inferior oblique muscle overaction (IOOA) presented at baseline or during follow-up were selected and divided according to the first surgery performed concurrently with horizontal rectus surgery: without IO recession (NO-recess), with unilateral IO recession (UNIL-recess), and with bilateral IO recession (BIL-recess). The success (version normalisation or at least 2 points upgrade in severity scale [0–4] in the operated eye), recurrence rates, and the evolution of the non-operated IO muscles were evaluated.ResultsOne hundred and ten patients were included – 53 NO-recess, 26 UNIL-recess, and 31 BIL-recess. Medial rectus muscle posterior fixation sutures surgery (PFS) was performed in 88.2% of patients for esotropia. A recession with graded anterior transposition was the weakening IO procedure. In the NO-recess group, 28 (52.8%) patients normalised their mild IOOA after PFS surgery alone. In the UNI-recess group, the success rate was 88.5%, with 16 (61.5%) patients showing worsened IO muscle of the fellow eye, which prompted additional surgery in 10 patients. In the BIL-recess group, all 31 patients improved the adduction pattern of the operated eye for an 80.6% success rate (6 improved marginally).ConclusionGraded anterior transposition of the inferior oblique muscle effectively normalises versions. However, it’s frequent for a contralateral overaction to become manifest after unilateral IO surgery.

Evaluation of change in objective cyclotorsion after various inferior oblique–weakening procedures

PurposeTo study the effect of four types of inferior oblique–weakening procedures on ocular torsion: inferior oblique recession (IOR), recession and antero-positioning (RAP), anterior transposition as practiced by Elliot and Nankin (EN), and anterior and nasal transposition (ANT). MethodsThe medical records of 72 consecutive patients >10 years of age undergoing inferior oblique weakening for primary or secondary inferior oblique overaction (IOOA) with or without horizontal rectus surgery were reviewed retrospectively. The 106 included eyes were assigned to one of the four groups according to the type of inferior oblique–weakening procedure. The severity of IOOA and the amount of V pattern guided the choice of procedure. IOOA, disk-fovea angle (DFA), and the amount of V pattern were recorded preoperatively. Measurements were repeated postoperatively at 1 week, 4 weeks, and 3 months. Change in the DFA was used to study the change in objective cyclotorsion in all four groups. ResultsA significant incyclotorsional shift was seen in all four groups at postoperative 3 months. The mean reduction in excyclotorsion 3 months postoperatively was 3.65° ± 4.84° for IOR, 5.31° ± 4.64° for RAP, 6.10° ± 3.89° for EN, and 16.62° ± 8.72° ANT; it was significantly higher in the ANT group compared with the other three groups. Reduction in DFA was also correlated with preoperative DFA overall, and for all procedures except IOR (P ≤ 0.005). ConclusionsAll four inferior oblique–weakening procedures reduced excyclotorsion; the largest reductions in our study were seen in cases treated using ANT of the inferior oblique.

Outcomes of inferior oblique myectomy versus recession combined with lateral rectus recession in V-pattern exotropias

PurposeTo compare outcomes of bilateral lateral rectus recession (BLRc) paired with either bilateral inferior oblique myectomy (BIOm) or bilateral inferior oblique recession (BIOc) to correct V-pattern exotropia. MethodsThe medical records of children (≤18 years) who underwent BLRc with BIOm or BIOc (10 mm) for V-pattern intermittent exotropia between December 2020 and May 2022 and who had at least 6 months’ postoperative follow-up were reviewed. Outcomes included horizontal alignment, bilateral inferior oblique action, stereopsis, postoperative exotropia control score, and additional strabismus surgeries. Analysis was stratified by preoperative V pattern into subgroups of 10Δ-14Δ and ≥15Δ. ResultsFifty patients underwent BLRc with BIOm (n = 26) or BIOc (n = 24), with no difference in age, sex, or follow-up length. Preoperatively, there were no differences in stereopsis, horizontal or vertical deviations in primary position, strabismus control, or inferior oblique overaction (IOOA). The BIOc group had greater preoperative V pattern than the BIOm group (18.1 ± 6.8 D vs 14.3 ± 7.0 D, resp. [P = 0.03]). There was no difference in BLRc surgical dose. At final follow-up (mean, 448 ± 189 days), both groups showed a postoperative decrease in horizontal deviation, amount of V pattern, and IOOA. For patients with ≥15Δ V pattern, BIOm decreased V pattern amount at distance (P = 0.02) and IOOA (P = 0.0035) more than BIOc, and BIOm patients had better control of residual strabismus at distance (P = 0.03) compared with the BIOc group overall, as well as for both V pattern subgroups. Two patients with BIOm and one with BIOc underwent additional strabismus surgery. ConclusionsBIOm or BIOc in combination with BLRc decreased the angle of exotropia and improved control. However, BIOm, especially with large V patterns, had a greater effect on decreasing the V pattern and IOOA and showed better control of residual strabismus.

Postoperative outcomes for unilateral congenital trochlear nerve palsy: A retrospective cohort study

Congenital trochlear nerve palsy is the most common cause of vertical strabismus. The goal of this study was to investigate surgical outcomes after superior oblique tendon plication with or without inferior oblique recession in children and adults with unilateral congenital trochlear nerve palsy. Data and outcomes were collected in patients with a diagnosis of unilateral congenital superior oblique palsy during a retrospective single-center study conducted at the University Hospital of Tours. A reproducible, standard ophthalmological and oculomotor examination was performed pre- and postoperatively at 1 year, including presence or absence of diplopia, vertical and horizontal deviations, and compensatory head posture. Surgical success, defined as an endpoint including absence of diplopia in primary position, absence of head tilt, and vertical deviation at distance fixation<5 prism diopters (PD), was analyzed. A total of fifty-seven patients (median [IQR] age of 11 years [5-42]) were analyzed. Patients experienced a significant reduction in vertical distance and near deviations (p<0.001), compensatory head tilt (p<0.001), and diplopia after surgery (p<0.001). Surgical success was higher in adults (17/24, 70.8%) than in children (15/33, 45.5%), although this did not reach statistical significance (p=0.0657). This study suggests that plication of the superior oblique muscle tendon, with or without recession of the inferior oblique muscle, can be effective in treating unilateral congenital trochlear nerve palsy. Further studies are necessary to compare surgical procedures and investigate their efficacy in adults compared to children in the short and long term.

Efficacy of inferior oblique belly transposition combined with inferior oblique recession for asymmetric inferior oblique overaction

ObjectifÉvaluer l'efficacité de la transposition du ventre de l'oblique inférieur (IOBT) associée à la récession de l'oblique inférieur (OI) pour la correction d'une hyperaction asymétrique bilatérale de l'oblique inférieur (IOOA). MéthodesAnalyse rétrospective des données de 14 patients qui ont subi une IOBT du côté où l'IOOA asymétrique bilatérale était légère et une récession de l'OI du côté où l'IOOA était grave. On a examiné les principaux résultats chirurgicaux obtenus, dont la correction de l'IOOA, de l'hypertropie, de la déviation horizontale, de l'incomitance V et de l'angle de l'axe disque optique-fovéa. RésultatsLa valeur préopératoire (+1,86 ± 0,53) de l'IOOA du côté le moins atteint est passée à +0,07 ± 0,27 (p < 0,001) après l'IOBT; du côté le plus atteint, l'IOOA est passée de +3,14 ± 0,53 à +0,14 ± 0,36 après la récession de l'OI (p < 0,001). La déviation verticale en position primaire en vision de loin est passée de 8,43 ± 4,05 DP à 1,21 ± 1,48 DP après l'intervention (p < 0,001). L'incomitance V moyenne se chiffrait à 25,00 ± 11,62 DP avant l'intervention et à 3,18 ± 2,18 DP après cette dernière (p < 0,001). L'angle de l'axe disque optique-fovéa moyen est passé de –10,47 ± 5,85 degrés à –7,82 ± 6,42 degrés (p = 0,023) du côté où a été réalisée l'IOBT, et de –11,05 ± 5,14 degrés à –6,09 ± 4,52 degrés (p = 0,001) du côté soumis à la récession de l'OI. Le taux de réussite global était de 71,4 % (10 patients sur 14). ConclusionsL'association d'une IOBT à une récession de l'OI est une technique efficace et sûre pour éliminer l'hypertropie, l'incomitance V et l'extorsion en présence d'IOOA asymétrique bilatérale.

Temporal Slant Recession of the Inferior Rectus Muscle: A Simple Surgical Treatment for Diplopia Caused by Small Vertical Deviations.

To evaluate the therapeutic effect of temporal slant recession of the inferior rectus muscle (TSRIRM) for the treatment of small vertical deviations in patients with vertical diplopia, with consideration of the theoretical additive effects of this procedure on ocular torsion and horizontal incomitance. Retrospective review of 11 patients who were treated with TSRIRM. Eight patients with vertical diplopia and small hyperdeviations (up to 6 prism diopters (PDs)) were treated with isolated TSRIRMs. Three patients with vertical diplopia from unilateral superior oblique palsies with large hyperdeviations (>15 PDs) were treated with TSRIRMs in conjunction with contralateral inferior oblique recessions. Six of the 8 patients with small vertical deviations had successful vertical realignment with elimination of symptomatic diplopia after an isolated TSRIRM. Two of the eight patients had residual hypertropia with symptomatic diplopia. Three additional patients with unilateral superior oblique palsy had successful vertical realignment with elimination of symptomatic diplopia after ipsilateral inferior oblique recession and contralateral TSRIRM. In total, 9 of 11 patients had successful surgical results after TSRIRM. TSRIRM provides an effective and reliable treatment for small angle vertical strabismus. Its ease of surgical access renders it useful for implementation in an outpatient neuro-ophthalmology setting.

AOC workshop on strabismus and amblyopia: we're in arizona—let's count the vote! searching for truth in the desert

As pediatric ophthalmologists and orthoptists we often worship those who served as our mentors and maintain practice patterns despite conflicting evidence in the literature. This workshop will address strabismus and amblyopia topics where practice varies widely, indicating a need for more rigorous study. Ophthalmologists and orthoptists will debate best practices on topics including: vision screening in young children, inferior oblique recession as a necessary procedure, importance of preoperative surgical measurements, adherence to occlusion therapy guidelines, value of the synoptophore.

Inferior Oblique Recession with 5 mm Loop to Correct Vertical Deviation and Inferior Oblique Overaction Secondary to Superior Oblique Palsy

ABSTRACT Purpose: To evaluate the effect of augmented inferior oblique recession (recession +5 mm loop) on the vertical deviation in primary position (PP) and the inferior oblique overaction (IOOA) in patients with unilateral congenital or acquired superior oblique palsy. Patients and methods: The medical records of patients who underwent unilateral inferior oblique recession with 5 mm loop during 2012 and 2019 were retrospectively reviewed. All patients had small to moderate manifest or intermittent hypertropia in PP and overaction of the inferior oblique muscle of +2 or +3 in lateral gaze. Patients who had combined inferior rectus surgery of the contralateral eye or who had previous vertical muscle surgery were excluded. Results: A total of 26 patients were included. Of these, three patients had combined horizontal muscle surgery. In 22 patients, the superior oblique palsy was congenital or longstanding, in 4 it was acquired and stable for more than 9 months. The mean preoperative vertical deviation in PP at distance and near was 14.7Δ and 11.2Δ, respectively. The mean postoperative vertical deviation was 5.7Δ and 4.1Δ after a mean follow-up of 19 months. The IOOA improved in all patients, 16 patients had an improvement of +2 and 10 patients had an improvement of +1. Conclusion: Inferior oblique recession with a 5 mm loop is a simple and quick technique to correct small to moderate hypertropia in primary position and inferior oblique overaction in contralateral gaze in patients with congenital, longstanding or acquired superior oblique palsy without risk of overcorrection.

Inferior oblique recession associated to partial temporal inferior rectus recession in unilateral congenital superior oblique palsy.

To evaluate the effectiveness of inferior oblique recession with contralateral partial temporal inferior rectus recession in patients with decompensated congenital unilateral superior oblique palsy (SOP) in correcting moderate vertical deviations in primary position. The medical records of patients with SOP who underwent inferior oblique recession with contralateral partial temporal inferior rectus recession were reviewed retrospectively. Vertical deviation in primary position, subjective torsion, diplopia, residual deviation, and the deviation decrease were evaluated. Four patients (three males and one female, age range 29-56 years) with congenital unilateral SOP and mean vertical deviation of 21.0 ± 5.3PD (range 14-25D) in primary position were included. Mean correction of hypertropia in primary position with this technique was 15.5 ± 5.3PD (range 10-20PD). The mean hypertropia on gaze to the contralateral side changed from 30.0 ± 10.8D before surgery to 9.3 ± 7.9D after surgery. Torsion had a mean change of 4.8° of incyclodeviation. Preoperatively, all patients had head tilt and diplopia, which was resolved in all but one patient, who will need surgery. Patients were followed an average of 18 months. No adverse events were reported in any subjects. When performing recession of inferior oblique muscles in SOP associated to a full recession of the contralateral inferior rectus, there is a risk of overcorrection in those with moderate angles. Performing a partial recession in the contralateral inferior rectus eye corrected up to 20PD in primary position in our series, reducing this risk.

Bilateral hypotropic dissociated vertical deviation: a case report\xa0

BackgroundHypotropic dissociated vertical deviation (DVD) is a special form of strabismus characterized by a slow drift of the non-fixating eye when the other eye is fixating on a target. In contrast to hypertropic DVD, which is common, hypotropic DVD is exceedingly rare and seldom reported in previous literature. In this case, we report the clinical features of a rare case of a Syrian child with bilateral hypotropic DVD accompanied by manifest latent nystagmus and intermittent exotropia.Case presentationA 4-year-old Syrian Arab girl presented with intermittent exotropia of both eyes since the age of 7 months, without any prior treatment. The fixation was alternating. She had manifest latent nystagmus in both eyes and anomalous head posture. She had bilateral hypotropic DVD in both eyes which only appeared when covering each eye. The patient underwent bilateral lateral rectus recession with posterior fixation and bilateral inferior oblique recession. Three months after surgery, she was orthophoric in the primary gaze position with a normal head posture. No alteration of the appearance of the hypotropic DVD was observed after the surgery.ConclusionThis is a rare case of hypotropic DVD showing bilateral hypotropic DVD with different characteristics from those previously reported cases (bilateral hypotropic DVD with intermittent exotropia, dissociated horizontal deviation, manifest latent nystagmus, and bilateral inferior oblique overaction). The hypotropic DVD only appeared when covering each eye, and thus there was no need for surgery. Moreover, the inferior oblique recession did not seem to negatively affect the appearance of the eyes.

Comparison of excyclotorsion following graded inferior oblique recession for primary versus secondary inferior oblique overaction.

To compare the changes in excyclotorsion after inferior oblique (IO) recession in patients with primary and secondary inferior oblique overaction (IOOA). We retrospectively analyzed the data obtained from patients with IOOA who underwent graded IO recession. The patients were followed up for at least 3mo after surgery. Fundus photographs were taken pre- and postoperatively, and the sum of the angles of torsion in both eyes was used to analyze changes in excyclotorsion. Patients were divided into two groups: those diagnosed with primary IOOA were enrolled in the 1'IOOA group, and those diagnosed with secondary IOOA caused by superior oblique palsy (SOP) were enrolled in the 2'IOOA group. Excyclotorsion before and after surgery were compared between the two groups. A total of 78 patients were enrolled in this study: 34 eyes in the 1'IOOA group and 44 eyes in the 2'IOOA group. In the 78 patients, torsional angle significantly decreased from 15.31°±7.40° to 12.11°±6.53° after IO recession (P<0.001). Mean preoperative torsional angle was larger in the 2'IOOA group than in the 1'IOOA group (P=0.03). In both groups, excyclotorsion significantly decreased after IO recession (P=0.001 and P<0.001, respectively); however, there was no significant difference in the amounts of changes in excyclotorsion between the two groups. Excyclotorsion is significantly larger in secondary IOOA than in primary IOOA, and a significant decrease in the torsional angle occurs after IO recession in both types of IOOA.

Self-grading effect of inferior oblique myectomy and recession

To evaluate the outcomes of inferior oblique (IO) weakening surgery, whether recession or myectomy, and to assess the dose-response relationship and correlation with angle of preoperative hypertropia. The medical records of all patients with vertical deviation in primary gaze who underwent unilateral IO-weakening surgery, either recession or myectomy, at Boston Children's Hospital over an 8-year period with a minimum postoperative follow-up of 1month were reviewed retrospectively. Outcome measures were effect of IO weakening surgery on vertical deviation in primary gaze and its correlation with the preoperative angle of hyperdeviation. Secondary outcomes included resolution of abnormal head posture, reduction of ocular torsion, and postoperative under- and overcorrection. A total of 94 patients were identified (mean age at surgery, 29.3±19.8years; range, 1-69). The mean postoperative follow-up period was 17.2±15months. IO recession was performed in 30 patients; IO myectomy, in 64. Surgical success in primary position was achieved in 72 patients (77%), with resolution of anomalous preoperative head posture in 93%. The mean effect on alignment in primary position was 11.3Δ ± 6.8Δ. The response to IO-weakening surgery was strongly correlated with the preoperative hyperdeviation for both recession (R2=0.53) and myectomy (R2=0.87). As with other types of strabismus surgery, IO weakening has a "self-grading" contribution, in which the surgical effect strongly correlates with the magnitude of preoperative deviation. A large range of vertical misalignment can be corrected with the same surgical approach.

Comparison of conventional and Hang-back methods of inferior oblique recession in V-pattern strabismus with inferior oblique overaction.

To compare outcomes of conventional and Hang-back methods of inferior oblique (IO) recession in V-pattern strabismus with inferior oblique overaction (IOOA). Comparative randomized study was conducted consisting of 50 patients, age 6 to 35y having V-pattern strabismus [>15 prism diopter (PD)] with IOOA. They were divided equally in two groups and underwent IO recession, group A by conventional method and group B by Hang-back method. Parameters evaluated were reduction in V-pattern and IOOA, shift in torsion, improvement in binocular status. Success was a residual V-pattern of less than 10 PD at 1y of follow up. The mean V-pattern preoperatively and postoperatively at 1y was 24±5.4 PD and 4.2±3.51 PD in group A and 23.44±6.44 PD and 5.76±3.8 PD in group B respectively. The mean reduction in V-pattern was 20±6.78 PD in group A and 18.2±5.48 PD in group B. The mean correction of IOOA was 18.48±3.13 PD in group A and 16±2.93 PD in group B. Mean shift in extorsion was 3.08±1.8 degree in group A and 3.72±2.14 degree in group B. Both the procedures achieve a significant and comparable reduction in V-pattern and IOOA. Hang-back recession being a landmark free surgery eliminates the need for intrascleral suturing thereby reducing the risk of scleral perforation with possible postoperative adjustment of muscle. It may be considered as a good alternative for IO recession in patients of V-pattern strabismus with mild to moderate amount of IOOA.

Comparison of Techniques for Correction of Chin-down Vertical Abnormal Head Position Associated with Infantile Nystagmus Syndrome

We evaluated the relative effectiveness of combined recession-resection of vertical rectus muscles versus superior rectus recession with inferior oblique weakening for patients who underwent surgical correction of chin-down abnormal head position (AHP) associated with infantile nystagmus syndrome (INS). Retrospective interventional case series. This is a review of 22 patients who underwent surgical correction of chin-down vertical AHP associated with INS at an academic institution. The primary outcome was collapse of AHP. Unfavorable outcomes included repeat surgery and induced strabismus, in addition to failure of collapse of AHP. Twenty-two patients had chin-down AHP. Recession-resection (bilateral superior rectus recession 6-9mm; bilateral inferior rectus resection 5-9mm) was performed in 11 cases; weakening of both elevators (bilateral superior rectus recession 5-8mm, bilateral inferior oblique recession or myectomy) occurred in 11 cases. Unfavorable outcome rates were 64% (7/11) compared with 18% (2/11), respectively (P= .03). Reoperation was performed for 6 of 22 patients. Five patients were from the recession-resection group, namely 3 for induced V-pattern esotropia, 1 for alternating esotropia, and 1 to correct recurrent AHP. The last of the 6 who required reoperation was in the elevator weakening group, and required correction of a recurrent AHP (P= .06). While recession-resection of the vertical recti and weakening of both elevators each produce acceptable collapse of chin-down AHP, the former frequently induces a V-pattern esotropia requiring reoperation.

Changes in Esodeviation after Inferior Oblique Recession in Patients with Refractive Accommodative Esotropia and Inferior Oblique Overaction.

PurposeTo evaluate the changes in esodeviation after inferior oblique (IO) recession in patients with refractive accommodative esotropia and IO overaction.MethodsGraded IO recession was performed in 68 patients who were diagnosed with refractive accommodative esotropia with IO overaction. The patients were followed for at least 3 months after surgery and the angle of esodeviation with correction was evaluated at distance and near at each follow-up evaluation. The patients were divided into two groups: patients who underwent unilateral IO recession (UIO-Rec) and patients who underwent bilateral IO recession (BIO-Rec). The change in esodeviation after surgery was compared between the two groups.ResultsA total of 68 patients were enrolled in this study, with 38 patients in the UIO-Rec group and 30 in the BIO-Rec group. In the UIO-Rec group, there was no statistically significant difference in esodeviation before and after surgery. In the BIO-Rec group, esodeviation at distance increased significantly 1 day postoperatively (p = 0.033). However, esodeviation returned to the preoperative value one week after surgery (p = 0.665). Changes in esodeviation at distance were significantly greater in the BIO-Rec group than in the UIO-Rec group one day after surgery (p = 0.044).ConclusionsBilateral IO-weakening surgery induced a transient increase in esodeviation in patients with refractive accommodative esotropia. However, we found no evidence that well-controlled esotropia with corrected hyperopia became decompensated after IO-weakening surgery, as induced esodeviation was minor and temporary.

Superior Oblique Palsy: Efficacy of Isolated Inferior Oblique Recession in Cases with Ipsilateral Hypertropia in Abduction

ABSTRACTPurpose: To evaluate the effects of isolated inferior oblique (IO) muscle recession in patients with superior oblique palsy (SOP) and persistent hypertropia in abduction.Methods: Retrospective review of patients with unilateral SOP who were treated with isolated IO recession by a single surgeon (MCB) between January 2008 and December 2017. We included patients with congenital and acquired fourth nerve palsies, with a hyperdeviation of less than 20 prism diopters in primary position and at least 4 prism diopters in abduction by prism and alternate cover test (PACT) during distance fixation. A minimum follow-up of 4–6 weeks was required. Age at surgery, etiology, presence of head tilt, motor alignment in primary and secondary gaze positions at distance and near using PACT, versions, ductions, and torsion were recorded from the patients’ chart.Results: Seven patients with SOP were included in this study. Four (57.14%) males, with a mean age at presentation of 41.86 years (range: 6–66 years). Mean follow-up was 13.25 months (range: 1.3–52.2 months). A decrease in mean central gaze hypertropia from 11.4 to 1.71 PD was found. A mean contralateral gaze hypertropia that decreased from 22.28 to 5.71 PD and an ipsilateral gaze hypertropia that improved from 5.86 to 1.14 PD were also noted. Torsion had a mean change of 3.4° of incyclodeviation at the final examination.Conclusions: This study confirms the efficacy of isolated maximal IO recession for the treatment of unilateral SOP that is accompanied by a modest hypertropia of the paretic eye in abduction.

Surgical outcomes of inferior oblique muscle weakening procedures for eliminating inferior oblique muscle overaction: a prospective randomized study

Purpose The aim of this study was to evaluate the outcomes of weakening surgical procedures for eliminating inferior oblique muscle overaction (IOOA). Patients and methods A prospective randomized interventional study was performed on 20 eyes of 12 patients with IOOA. The eyes were classified randomly into three groups. The first group included six eyes treated with inferior oblique (IO) myotomy. The second group included eight eyes treated with IO myectomy. The third group included six eyes treated with IO muscle recession. The ductions, versions, and degree of IOOA were analyzed in all patients before and after surgery. Patients were included in the study only if they achieved a minimal follow-up period of 3 months. Results Orthotropia was achieved in 13 (65%) eyes: three (15%) eyes in IO myotomy group, five (25%) eyes in IO myectomy group, and five (25%) eyes in IO recession group. One (5%) eye of IO myotomy group showed residual degree of IOOA. Underaction of IO occurred in one (5%) eye of IO myectomy and recurrence occurred in five (25%) eyes of all groups. Conclusion Recession is the most effective procedure to eliminate IOOA, whereas myectomy at insertion is the second most effective procedure and myotomy is the least effective procedure.

Simultaneous Superior Rectus Recession and Anterior Transposition of Inferior Oblique Muscle as a Surgical Option for Traumatically Lost Inferior Rectus Muscle

ABSTRACTPurpose: To evaluate the role of simultaneous superior rectus (SR) recession and anterior transposition of inferior oblique (ATIO) muscle in patients with traumatically lost inferior rectus (IR) muscle.Methods: Six patients with history of ocular trauma, followed by sudden onset vertical diplopia along with marked hypertropia (HT) and limitation of depression in abduction in the affected eye suggestive of IR disinsertion, were included in this prospective study. The patients were treated by simultaneous SR recession and ATIO muscle in the affected eye by limbal conjunctival approach under local anesthesia.Results: Preoperatively, primary position HT of 40–50 (mean 44.16 ± 4.91) prism diopters (PD) was present in all cases which increased to 65–70 (mean 65.83 ± 5.84) PD in down and in the ipsilateral gaze along with marked limitation of depression in abduction and A pattern. On exploration, the IR could not be traced in four cases. Fibrotic muscle sheath with retracted IR was found 10–12 mm away from the limbus in rest of the two patients. ATIO (6.5 mm from the limbus) with simultaneous recession of ipsilateral SR was done under local anesthesia.At 12 weeks postoperatively, three patients were orthophoric in primary position and vertical alignment with in 4–7 PD in primary position was achieved in rest of the three patients.Conclusion: Simultaneous SR recession with ATIO seems to be a good alternative to achieve satisfactory vertical alignment for patients with traumatically lost inferior rectus muscle.