Recession Of Inferior Oblique Muscle Research Articles

Evaluation of graded recession of inferior oblique muscle for correction of different grades of V-pattern strabismus

BackgroundV pattern identification is essential for proper strabismus management. Graded recession is a tailored approach to treat inferior oblique overaction (IOOA). The aim is to evaluate the efficacy of graded recession of inferior oblique muscle for correction of different grades of V pattern.MethodsForty patients from 3 to 18 years old with V pattern strabismus and primary IOOA were evaluated by prism cover test to assess the grade of IOOA and amplitude of V-pattern. Graded recession of IO muscle depends on the amplitude of the V-pattern and degree of IOOA. Eight mm recession for amplitude 15 PD to 20 PD and mild IOOA (10 PD-15 PD or + 1) ,10 mm recession for amplitude 20–30 PD and moderate IOOA (15–25 PD or + 2) and maximum recession for amplitude more than 30 PD and marked IOOA (≥ 25 PD or + 3). Simultaneous correction of the horizontal deviation was performed. Follow up after I week,1 month ,3 month and 6-month. Trial Registration Number (TRN) (NCT05786053) on 23/3/2023.ResultsThe mean age of the study patients was 9 ± 4.261. Twenty patients (50%) had V-pattern esotropia, 12 (30%) exotropia, 4 (10%) orthotropic and four (10%) had Dissociated vertical deviation (DVD). Four cases 10% were of grade 1, 20 cases (50%) grade 2 and 16 cases (40%) were of grade 3. Of eighty eyes, 66 eyes (82.5%) were fully corrected with no residual IOOA, and 14 eyes (17.5%) were under corrected. V-pattern was corrected in 28 cases 70% and only 12cases (30%) had residual V-pattern grade 1.ConclusionsGraded recession is an effective procedure for correction of V pattern strabismus with various grades of primary inferior oblique overaction. It can be tailored according to the the degree of IO overaction which is significantly related to the grade of V pattern. The 8 mm recession for IO was significantly related to recurrence or inadequate break of the V pattern in our studied cases. The grade of IOOA correlates with the amplitude of V-pattern. The amount of recession was planned according to preoperative IOOA and grade of V-pattern with frequent undercorrections obtained by the standard 8 mm recession. A + 2 overaction merits a 10-mm recession of the inferior oblique. A + 3 or + 4 overaction merits a 14-mm maximal recession.

COMPARATIVE STUDY BETWEEN INFERIOR OBLIQUE RECESSION AND INFERIOR OBLIQUE RETRO-EQUATORIAL SCLERAL FIXATION (MYOPEXY) IN MANAGEMENT OF PRIMARY INFERIOR OBLIQUE OVER ACTION

Background: Weakening procedures on the inferior oblique muscle are numerous and include myectomy, graded recession- anteriorization, anterior transposition, anterior and nasal transposition, myotomy, marginal myotomy, nasal myotomy, disinsertion, and denervation and extirpation. Recently, New surgical Intervention for weakening of the inferior oblique muscle is inferior oblique retro-equatorial scleral fixation ( Myopexy). Objective: The aim of the study was to compare between recession of inferior oblique muscle(IO) and retroequatorial scleral fixation (myopexy) of inferior oblique muscle in management of primary inferior oblique over action.(IOOA) Patients and Methods: Thirty patients (60 eyes) presented by horizontal strabismus and primary inferior oblique over action, met the inclusion criteria, and were divided into two equal groups: Group A treated by recession of the inferior oblique muscle. And Group B treated by retro-equatorial scleral fixation (myopexy) of the inferior oblique muscle. Results: Both IO graded recession and IO myopexy were equally effective in correcting the degree of IOOA (elevation in adduction) , correcting associated pattern,with no statistical significant difference and both were equally effective in correcting the degree of objective fundus extorsion with no statistical significant difference. Conclusion: Our findings suggested that both surgical groups had positive outcomes, with good response and effect which was stable all over follow up visits uptill 6 months.

COMPARATIVE STUDY BETWEEN INFERIOR OBLIQUE RECESSION AND INFERIOR OBLIQUE RETRO-EQUATORIAL SCLERAL FIXATION (MYOPEXY) IN MANAGEMENT OF PRIMARY INFERIOR OBLIQUE OVER ACTION

Background: Weakening procedures on the inferior oblique muscle are numerous and include myectomy, graded recession- anteriorization, anterior transposition, anterior and nasal transposition, myotomy, marginal myotomy, nasal myotomy, disinsertion, and denervation and extirpation. Recently, New surgical Intervention for weakening of the inferior oblique muscle is inferior oblique retro-equatorial scleral fixation ( Myopexy). Objective: The aim of the study was to compare between recession of inferior oblique muscle(IO) and retroequatorial scleral fixation (myopexy) of inferior oblique muscle in management of primary inferior oblique over action.(IOOA) Patients and Methods: Thirty patients (60 eyes) presented by horizontal strabismus and primary inferior oblique over action, met the inclusion criteria, and were divided into two equal groups: Group A treated by recession of the inferior oblique muscle. And Group B treated by retro-equatorial scleral fixation (myopexy) of the inferior oblique muscle. Results: Both IO graded recession and IO myopexy were equally effective in correcting the degree of IOOA (elevation in adduction) , correcting associated pattern,with no statistical significant difference and both were equally effective in correcting the degree of objective fundus extorsion with no statistical significant difference. Conclusion: Our findings suggested that both surgical groups had positive outcomes, with good response and effect which was stable all over follow up visits uptill 6 months.

This issue of Acta

This issue of Acta

Results after graded recession of inferior oblique muscle in strabismus sursoadductorius

Introduction: Idiopathic strabismus sursoadductorius is characterized by an overaction of the inferior oblique (IO) muscle, with elevation of the eye in adduction. This can result in chronic headache, eye pain, diplopia and abnormal head posture. Aim: Presentation of clinical results after graded recession of inferior oblique overaction (IOOA) in strabismus sursoadductorius. Method: During a period of 6 years (2012-2017) we performed a dosed transposition of IO muscle in 53 patients in the Department of Ophthalmology of the Semmelweis University and analyzed the clinical results retrospectively. The mean age was 12.8, min-max: 2-51 years. The transposition of the muscle (8 mm, 10 mm or maximal) was performed because of IOOA and was planned depending on the vertical deviation (VD) in maximal adduction. In case of maximal transposition, the insertion of IO was placed under the lateral part of the lower rectus muscle. We evaluated the squint angle in five positions of gaze preoperatively and postoperative 1 week, 1 month and 3-6 months. We examined best corrected visual acuity, binocular vision and complications after surgery. Results: Postoperatively 25 patients had acceptable stereopsis (Titmus 5). Visual acuity remained stable after surgery in all cases. The VD measured in maximal adduction changed with a decrease of 7.5° when 8 mm transposition was performed, and changed with a decrease to 12°, when maximal recession was performed. The mean reduction of VD was 17.8 prism dioptres (PD) after 1 week (p<0.01), 20.5 PD after 1 month and remained stable during a follow-up of 3-6 months. Conclusion: Graded recession of inferior oblique muscle is a suitable proposed procedure in patients with marked strabismus sursoadductorius. The rates of functional under- or overcorrection or other complications are low. Orv Hetil. 2019; 160(27): 1064-1069.

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.

A standardized recession of the inferior oblique extraocular muscle - a safe and self-grading surgical procedure for trochlear nerve palsy: a 10-year material.

To evaluate the results of surgical treatment in a large group of patients with trochlear nerve palsy, with emphasis on the self-grading effect of a standardized recession of the ipsilateral inferior oblique muscle. All patients who underwent first-time surgery for trochlear nerve palsy in the period 2005-2014 in our department (n=114) were retrospectively evaluated regarding pre- and postoperative data, surgical procedure, and the need for reoperations. Mean follow-up time was 8.5±13.8months. Among the 114 patients, 73 (64.0%) had a congenital palsy, 31 (27.2%) an acquired palsy, while in 10 cases (8.8%) the type of palsy was uncertain. A standardized recession of the ipsilateral inferior oblique muscle with reattachment at the lateral border of the inferior rectus muscle was carried out in 97.3% of the congenital palsies and in 80.5% of the acquired/uncertain group. In the total patient material, further surgery was needed in 15.8%. Among the patients who underwent a single standardized recession of the inferior oblique muscle, a significant correlation between preoperative vertical angle of deviation and the postoperative change in deviation was demonstrated (correlation coefficient -0.70, p<0.001), confirming the self-grading nature of this procedure. Subjectively, 97.1% in the congenital and 91.4% in the acquired/uncertain group reported complete/near complete resolution or significant improvement of their symptoms at the final control examination. In the majority of patients with trochlear nerve palsy, a favourable outcome may be achieved after a single, standardized recession of the ipsilateral inferior oblique muscle.

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.

Alt Oblik Kas Hiperfonksiyonu Tedavisinde Alt Oblik Kas Geriletmesi ve Miyektomi Yöntemlerinin Karşılaştırılması

Amaç: Primer ve sekonder alt oblik kas hiperfonksiyonu (AOHF) düzeltilmesinde kullanılan alt oblik kas geriletmesi ve miyektomi yöntemlerinin sonuçlarının karşılaştırılmasıdır. Gereç ve Yöntemler: Ocak 2007-Aralık 2014 tarihleri arasında farklı derecelerde AOHF nedeniyle alt oblik kas zayıflatma cerrahisi uygulanan 74 hastanın 120 gözü bu retrospektif çalışmaya dâhil edildi. Hastaların demografik özellikleri, uygulanan cerrahi türü, cerrahi öncesi ve sonrası AOHF derecesi, eşlik eden horizontal kayma ve komplikasyonlar kaydedildi. Hastaların takip süresi medyan değeri 22 ay idi. Cerrahi sonrası AOHF'nin tamamen ortadan kalkmasında standart başarı kriterinin +1 düzeyinde olması ise sınırlı başarı kriteri olarak belirlendi. Bulgular: Hastaların medyan yaşı 7,0 yıl (1,0-32,0), medyan takip süresi 22,0 ay (1,0-81,0) idi. Kırk dokuz (%62,6) hastada primer AOHF, 25 (%33,8) hastada ise sekonder AOHF mevcuttu. Altmış üç (%52,5) göze alt oblik kas miyektomisi, 57 (%47,5) göze alt oblik kas geriletmesi yapıldı. Standart başarı oranları miyektomi için %82,5, geriletme için %82,4 idi. Miyektomi yapılan gözlerin %12,7'sinde, geriletme yapılan gözlerin %10,5'inde sınırlı başarıya ulaşıldı. Hastaların cerrahi öncesi ve sonrası AOHF düzeylerindeki fark yönünden miyektomi ve geriletme yöntemleri arasında anlamlı fark saptanmadı (p=0,163). Cerrahi sonrası toplam 14 (sekiz göze miyektomi, altı göze geriletme yapılmış) gözde nüks ve 2 (ikisine de miyektomi yapılmış) gözde adezyon sendromu geliştiği gözlendi. Başka bir komplikasyon izlenmedi. Sonuç: Primer ve sekonder AOHF tedavisinde uygulanan alt oblik kas miyektomi ve geriletme yöntemleri etkili ve güvenilir yöntemlerdir. Her iki yöntem de benzer başarı oranlarına sahiptir. Tekrar cerrahi ihtiyacı olan hastalarda geriletme yönteminin avantajı kasa daha kolay ulaşılmasını sağlamasıdır.

Clinical factors underlying a single surgery or repetitive surgeries to treat superior oblique muscle palsy.

The purpose of this study is to know clinical factors underlying either a single surgery or repetitive surgeries, required to treat superior oblique muscle palsy. Retrospective review was made on 246 consecutive patients with idiopathic (n = 212) or acquired (n = 34) superior oblique muscle palsy who underwent surgeries in 8 years at one institution. Idiopathic palsy included congenital and decompensated palsies while acquired palsy included traumatic and ischemic palsies. Clinical factors, compared between groups with a single surgery (n = 203) and two or more surgeries (n = 43), were surgical methods, sex, age at surgery, horizontal, vertical, and cyclotorsional deviations, and stereopsis at near fixation. Inferior oblique muscle recession on paretic side was chosen in about 60% of the single-surgery and repetitive-surgery group as an initial surgery, followed by inferior rectus muscle recession on non-paretic side. The age at surgery was significantly older, vertical and cyclotorsional deviations were significantly larger in the repetitive-surgery group, compared with the single-surgery group (P = 0.01, P < 0.001, P = 0.02, Mann–Whitney U-test, respectively). The 95% confidence interval of vertical deviations was 15–17 prism diopters in the single-surgery group and 23–28 prism diopters in the repetitive surgery group. Significant differences in vertical deviations were replicated also in subgroups of patients with either idiopathic or acquired palsy. In conclusions, the 95% confidence interval of vertical deviations, determined by alternate prism and cover test, would be used as a common benchmark for predicting either a single surgery or repetitive surgeries, required to treat idiopathic and acquired superior oblique muscle palsy, in the process of obtaining the informed consent.

Surgical management of long-standing antielevation syndrome after unilateral anterior transposition of the inferior oblique muscle

To investigate surgical management of patients with long-standing antielevation syndrome following unilateral anterior transposition of inferior oblique muscle. We present a series of 3 consecutive patients with significant hypotropia several years after unilateral anterior transposition surgery. An approach combining denervation-extirpation of the inferior oblique muscle and subsequent inferior rectus muscle recession and contralateral superior rectus muscle recession was used to manage all 3 patients. Denervation-extirpation surgery alone or with ipsilateral inferior rectus muscle recession were not enough to improve vertical misalignment in these patients. All 3 patients achieved successful results after denervation-extirpation surgery, ipsilateral inferior rectus muscle recession, and contralateral superior rectus muscle recession. In this case series, devervation-extirpation surgery on the inferior oblique muscle, ipsilateral inferior rectus recession, and contralateral superior rectus recession improved vertical misalignment in patients with long-standing antielevation syndrome after unilateral anterior transposition of the inferior oblique.

Evaluation of macular thickness change after inferior oblique muscle recession surgery.

Purpose:This study aimed to evaluate the changes in macular thickness following inferior oblique muscle recession surgery.Materials and Methods:Thirty-eight eyes from 21 patients undergoing ocular muscle surgery were included. Patients were grouped into three groups based on the type of surgical intervention: Group I (n = 12), inferior oblique recession surgery alone; Group II (n = 12), inferior oblique plus horizontal muscle surgery; Group III (n = 14), horizontal muscle surgery alone. Each eye was scanned using the optical coherence tomography (OCT) device preoperatively and on the first postoperative day to measure macular thickness.Results:Following surgery, a significant increase in foveal thickness occurred in Group I (P < 0.05) and Group II (P < 0.01). In addition, a statistically significant difference was observed between the groups with regard to the increase in foveal thickness (P = 0.016), with significantly lower changes in Group III.Conclusion:Our findings suggested that inferior oblique muscle recession surgery is associated with an increase in macular thickness.

Effect of strabismus surgery on torticollis caused by congenital superior oblique palsy in young children

Purpose:To evaluate the outcome of strabismus surgery for congenital superior oblique palsy (SOP) in relation to correction of head tilt and hypertropia. The cohort of patients mainly involved very young children. This is the first study to use a standardized instrument to objectively measure torticollis before and after surgery.Materials and Methods:A non-comparative interventional case series of 13 cases of congenital superior oblique palsy with head tilt, who underwent simultaneous superior oblique tuck and inferior oblique recession between Jan 2000 and Dec 2008, were studied.Results:The mean duration of SOP until surgery was 36.8 months. Of the 12 unilateral cases, 8 were right-sided. Mean follow-up period was 17 months (range 7-36). The outcome was determined at the last follow-up. Mean pre-and post-operative hypertropia (p.d.) in forced primary position was 19 ± 7 and 2 ± 6, respectively (P < 0.0001). The head tilt reduced from mean of 17 ± 9 to 2 ± 2 degrees (P < 0.0001). Success, defined as hypertropia <5 PD and head tilt less than 5 degrees, was achieved in 69% (9/13. C.I. 42-88%) and 85% (11/13. C.I. 56-96%), respectively. The success rate for achieving both criteria was 61.5% (C.I. 35-88%). Five patients required additional surgery; usually a contralateral inferior rectus muscle recession, which was successful in all cases. One case developed asymptomatic Brown syndrome (7.69% - C.I. 6.7-22.2).Conclusions:Simultaneous superior oblique tuck and inferior oblique muscle recession can successfully treat selected cases of congenital superior oblique palsy. About one-third required an additional procedure, which led to total normalization of the head position.

Does inferior oblique recession cause overcorrections in laterally incomitant small hypertropias due to superior oblique palsy?

AimTo evaluate the effects of inferior oblique muscle recession (IOR) in cases of laterally incomitant hypertropia <10 prism dioptres (PD) in central gaze thact 2t are clinically consistent with superior...

Inferior oblique muscle recession with and without superior oblique tendon tuck for treatment of unilateral congenital superior oblique palsy

To compare the surgical results in patients with congenital superior oblique palsy treated with inferior oblique recession (IOR) versus those treated additionally with superior oblique tendon tuck (IOR+SOT). A consecutive, nonrandomized series of patients with congenital superior oblique palsy with vertical deviations in adduction between 10° and 20° were retrospectively reviewed. In the first series, patients were treated with IOR; in the second series, patients were treated with IOR+SOT. We examined the effects of surgery on binocular alignment and on the field of binocular single vision. Each group consisted of 20 patients. Preoperative ocular deviations were similar in both groups. Postoperative residual vertical deviations were not different in the primary position or in downgaze; however, significantly better alignment was achieved in the IOR+SOT group in adduction and downgaze in adduction. Consecutive Brown pattern occurred in 18 of 20 patients who underwent IOR+SOT versus 5 of 20 who underwent IOR. Residual torsion was not statistically different. The field of binocular single vision improved to 92%(range, 28%-100%) after IOR and to 96% (range, 64%-100%) after IOR+SOT (P= 0.20). IOR alone is a suitable procedure for most congenital superior oblique palsies with a moderate-to-large vertical deviation in adduction, resulting in a lower incidence of consecutive Brown pattern than with IOR+SOT.

Behandlung des Strabismus sursoadductorius (congenital superior oblique palsy) im Kindesalter

The aim of this study was to evaluate the effect of inferior oblique muscle recession (IOR) in children with pure unilateral strabismus sursoadductorius (so-called congenital superior oblique palsy, CSOP) operated before age 11 years. A retrospective study of IOR in children with unilateral CSOP and surgery before age 11 years was undertaken. In most cases, recession and anteroposition of the anterior part of the inferior oblique tendon next to the lateral edge of the inferior rectus muscle was performed without fixation of the posterior part of the tendon. Main outcome measures were change in abnormal head tilt, change in vertical deviation, both in straight and contralateral side gaze, and evaluation of squint angles. Between 1997 and 2007, 36 consecutive children (aged 2 -10 years; 27 boys, 9 girls) received IOR for unilateral CSOP. The dose of IOR ranged between 6 and 12 mm. Vertical deviation in straight and contralateral gaze was reduced from median 5° (range 0 - 11°) and 12° (3 - 20°) to 0° (-2 - 8°) and 1° (-5 - 13°), respectively. Abnormal head tilt towards the contralateral shoulder was reduced from median 10° (0 - 20°) to 0° (-2,5 - 10°). Three children (8 %) received further extraocular muscle surgery within 2 years, one because of persistent hyperdeviation, and two because of consecutive hypodeviation of the operated eye. The results indicate that IOR with fixation of only the anterior part of the inferior oblique to the sclera is an effective treatment for strabismus sursoadductorius/CSOP in children. Undercorrection into a residual, well compensated stage is a satisfying result. Both overcorrection and elevation deficiency were rare.

Underacting Inferior Oblique Muscle Following Myectomy or Recession for Unilateral Inferior Oblique Overaction

To assess the incidence and investigate the functional impact of postoperative overcorrection following primary unilateral inferior oblique muscle recession and myectomy for inferior oblique overaction. A retrospective study of 79 consecutive patients undergoing inferior oblique myectomy (43) or recession (36) with a minimum 6 months of postoperative follow-up. All underwent ocular motility examinations preoperatively and postoperatively at approximately 2 weeks and 6 months. The vertical deviation in primary position and on contralateral gaze and inferior oblique versions and ductions on contralateral elevation were analyzed. At 6 months, 51 patients had no inferior oblique underaction (group 1), 23 of 28 who had developed inferior oblique underaction were asymptomatic (group 2), and the remaining 5 were symptomatic (group 3). The mean preoperative hyperdeviation was 12.9 (group 1), 13.1 (group 2), and 15 (group 3) prism diopters (PD) in primary position. Postoperatively, these measured 3.8 (group 1), 3.8 (group 2), and -7.8 (group 3) PD (- indicates deviation reversal). The mean preoperative and postoperative inferior oblique versions for these three groups were +2.7, +2.2, +2.2 units and +0.9, -1.0, -1.4 units, respectively. Inferior oblique underaction was common (28 patients, 35.4%), generally mild, persistent, and usually asymptomatic 6 months following surgery. Although uncommon (5 patients, 6.3%), symptomatic inferior oblique underaction required further surgery with a successful outcome. They included 2 patients with a history of head or orbital trauma and one with masked and one with highly asymmetric bilateral inferior oblique overaction.

Manifested strabismus in a case of Apert syndrome

A full-term female baby was diagnosed as having Apert syndrome with craniosynostosis, hypertelorism, syndactyly, polydactyly, and cleft plate. At her first ophthalmic visit at 8 months old, she was noted to have bilateral exophthalmos with epiblepharon on her lower lids, exotropia, and right inferior oblique muscle overaction (IOOA) and manifested right dissociated vertical deviation (DVD). There was no keratopathy or optic neuropathy. Bilateral lateral rectus muscles and right inferior oblique muscle recession were performed with correction of bilateral epiblepharon at 1 year of age. Orthotropia was achieved postoperatively. However, recurrent exotropia with left inferior oblique muscle overaction and manifested left DVD developed 2 years later. We performed left medial rectus muscle resection and left inferior oblique muscle recession, and the patient maintained orthotropia. Her best-corrected visual acuity was 6/8.6 in the right eye and 6/7.5 in the left eye at the latest follow-up. Amblyopia, OD, was still noted. We report this case of Apert syndrome with exophthalmos, exotropia, and IOOA. The exophthalmos progressed as the patient grew, thus the strabismus pattern changed during follow-up. Frequent follow-up and titrated management may be needed for such case to ensure good binocular vision.

Comparison of Inferior Oblique Myectomy, Recession, and Anterior Transposition in Unilateral Congenital Superior Oblique Palsy

Purpose: To compare the clinical outcomes of myectomy, recession, and anterior transposition (AT) of the inferior oblique muscle in congenital unilateral superior oblique palsy. Methods: A total of 40 patients who were followed for longer than three months postoperatively and, who underwent inferior oblique myectomy, recession, or AT were evaluated retrospectively. Results: We compared the result of inferior oblique myectomy, recession, and AT in congenital unilateral superior oblique palsy. The decreased amounts of inferior oblique overaction (IOOA) were 2.240.67, 2.000.76, 3.001.15 for myectomy, recession, and AT, respectively. Improvement of superior oblique underaction was 0.800.66, 0.860.83, 1.000.58, and the changes in hyperdeviation were 10.96PD, 8.25PD, 14.86PD for myectomy, recession, and AT, respectively. There were no significant differences among the surgical methods. The proportion of patients who showed IOOA in the contralateral eye after operation were 20.0% in myectomy, 25.0% in recession, and 57.1% in AT. Conclusions: The efficacies of myectomy, recession, and AT of inferior oblique muscle in the congenital unilateral superior oblique palsies showed no significant differences among methods. The AT group tended to show a larger effect than did the other methods, along with a high development percentage of contralateral eye IOOA. Based on these results, AT of the IO shoud be selectively chosen in more severe cases.