Advertisement

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

Published:November 10, 2022DOI:https://doi.org/10.1016/j.jcjo.2022.10.016

      Abstract

      Objective

      To evaluate the efficacy of inferior oblique belly transposition (IOBT) combined with inferior oblique (IO) recession in treating bilateral asymmetric inferior oblique overaction (IOOA).

      Methods

      A retrospective review. The data of 14 patients who underwent IOBT on the mild side of IOOA and IO recession on the severe side for bilateral asymmetric IOOA were analyzed retrospectively. The main surgical results including the correction of IOOA, hypertropia, horizontal deviation, V pattern, and fovea–disc angle (FDA) were observed.

      Results

      The IOBT corrected the preoperative grade (+1.86 ± 0.53) of the mild-side IOOA to a postoperative grade (+0.07 ± 0.27; p < 0.001), and the severe-side IOOA was corrected from a grade of +3.14 ± 0.53 to a postoperative grade of +0.14 ± 0.36 by the IO recession (p < 0.001). The vertical deviation at distance in the primary position was decreased from 8.43 ± 4.05 PD preoperatively to 1.21 ± 1.48 PD postoperatively (p < 0.001). The mean V pattern was 25.00 ± 11.62 PD preoperatively and 3.18 ± 2.18 PD postoperatively (p < 0.001). The mean preoperative FDA on the side where IOBT was performed was –10.47 ± 5.85 degrees, and the postoperative FDA was –7.82 ± 6.42 degrees (p = 0.023). The mean FDA on the side with IO recession was –11.05 ± 5.14 degrees before surgery and –6.09 ± 4.52 degrees after surgery (p = 0.001). The overall success rate was 71.4% (10 of 14).

      Conclusions

      IOBT combined with IO recession is effective and safe in eliminating hypertropia, V pattern, and extorsion with bilateral asymmetric IOOA.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Choi DG
        • Chang BL.
        Electron microscopic study on overacting inferior oblique muscles.
        Korean J Ophthalmol. 1992; 6: 69-75
        • Scaramuzzi M
        • Serafino M
        • Vagge A
        • Nuzzi A
        • Rao G
        • Nucci P.
        The role of hypertropia in the surgical management of bilateral inferior oblique muscle overaction.
        J Binocul Vis Ocul Motil. 2022; 72: 18-21
        • Wilson ME
        • Parks MM.
        Primary inferior oblique overaction in congenital esotropia, accommodative esotropia, and intermittent exotropia.
        Ophthalmology. 1989; 96: 950-957
        • Caldeira JA.
        Some clinical characteristics of V-pattern exotropia and surgical outcome after bilateral recession of the inferior oblique muscle: a retrospective study of 22 consecutive patients and a comparison with V-pattern esotropia.
        Binocul Vis Strabismus Q. 2004; 19: 139-150
        • Yang S
        • Guo X
        • Tien DR.
        Inferior oblique belly transposition for small angle hypertropia with inferior oblique overaction: a pilot study.
        J Pediatr Ophthalmol Strabismus. 2018; 55: 43-46
        • Mostafa AM
        • Kassem RR.
        Comparative study of unilateral versus bilateral inferior oblique recession/anteriorization in unilateral inferior oblique overaction.
        Eur J Ophthalmol. 2018; 28: 272-278
        • Awadein A
        • Gawdat G.
        Bilateral inferior oblique myectomy for asymmetric primary inferior oblique overaction.
        J AAPOS. 2008; 12: 560-564
        • Kelkar J
        • Kanade A
        • Agashe S
        • Kelkar A
        • Khandekar R.
        Outcomes of asymmetric primary inferior oblique muscle overaction managed by bilateral myectomy and tucking of proximal muscle end: a cohort study.
        Middle East Afr J Ophthalmol. 2015; 22: 457-461
        • Huang YT
        • Chen JJ
        • Wu MY
        • et al.
        The effects of modified graded recession, anteriorization and myectomy of inferior oblique muscles on superior oblique muscle palsy.
        J Clin Med. 2021; 10: 4433
        • Mellott ML
        • Scott WE
        • Ganser GL
        • Keech RV.
        Marginal myotomy of the minimally overacting inferior oblique muscle in asymmetric bilateral superior oblique palsies.
        J AAPOS. 2002; 6: 216-220
        • Zhu W
        • Wang X
        • Jiang C
        • Ling L
        • Wu L
        • Zhao C.
        Effect of inferior oblique muscle belly transposition on versions and vertical alignment in primary position.
        Graefes Arch Clin Exp Ophthalmol. 2021; 259: 3461-3468
        • Ekmen MR
        • Polat S
        • Ülkü Can Ç
        • Koçak Altıntaş AG
        İnfantil Ezotropyalarda Alt Oblik Kas Hiperfonksiyonunun Ortaya Çıkış Zamanı ve Cerrahi Sonuçlarının Değerlendirilmesi.
        Türk Oftalmoloji Dergisi. 2013; 43: 419-423
        • Costenbader FD
        • Kertesz E.
        Relaxing procedures of the inferior oblique: a comparative study.
        Am J Ophthalmol. 1964; 57: 276-280
        • Elliott RL
        • Nankin SJ.
        Anterior transposition of the inferior oblique.
        J Pediatr Ophthalmol Strabismus. 1981; 18: 35-38
        • Del Monte MA
        • Parks MM.
        Denervation and extirpation of the inferior oblique: an improved weakening procedure for marked overaction.
        Ophthalmology. 1983; 90: 1178-1185
        • Parks MM.
        A study of the weakening surgical procedures for eliminating overaction of the inferior oblique.
        Trans Am Ophthalmol Soc. 1971; 69: 163-187
        • Helveston EM
        • Mora JS
        • Lipsky SN
        • et al.
        Surgical treatment of superior oblique palsy.
        Trans Am Ophthalmol Soc. 1996; 94 (discussion 328–34): 315-328
        • Bhatta S
        • Auger G
        • Ung T
        • Burke J.
        Underacting inferior oblique muscle following myectomy or recession for unilateral inferior oblique overaction.
        J Pediatr Ophthalmol Strabismus. 2012; 49: 43-48
        • Lee SY
        • Cho HK
        • Kim HK
        • Lee YC.
        The effect of inferior oblique muscle Z myotomy in patients with inferior oblique overaction.
        J Pediatr Ophthalmol Strabismus. 2010; 47: 366-372
        • Cruz FC
        • Robbins SL
        • Kinori M
        • Acera EC
        • Granet DB.
        Z-Myotomy of the inferior oblique for small incomitant hypertropias.
        J AAPOS. 2015; 19: 130-134
        • Tomarchio S
        • Sabetti L
        • Tomarchio M
        • Berarducci A.
        New surgical intervention for the weakening of the inferior oblique muscle: equatorial scleral anchor.
        J Pediatr Ophthalmol Strabismus. 2015; 52: 58-60
        • Yang SQ
        • Tien DR
        • Guo X.
        Inferior oblique belly transposition for V pattern strabismus (meeting abstract).
        Clin Exp Ophthalmol. 2019; 47: 160
        • Demer JL
        • Oh SY
        • Clark RA
        • Poukens V.
        Evidence for a pulley of the inferior oblique muscle.
        Invest Ophthalmol Vis Sci. 2003; 44: 3856-3865
        • Si M
        • Yang S
        • Tien DR
        • Yue Y
        • Shao X
        • Guo X.
        Inferior oblique belly transposition for V pattern strabismus.
        Strabismus. 2020; 28: 29-33
        • Su Y
        • Zhang CY
        • Wang DD
        • Yang SQ.
        Efficacy analysis of inferior oblique muscle belly transposition for small-angle asymmetric superior oblique palsy.
        Chin Med J (Engl). 2021; 134: 1492-1494
        • Haugen OH
        • Nepstad L.
        A standardized recession of the inferior oblique extraocular muscle—a safe and self-grading surgical procedure for trochlear nerve palsy: a 10-year material.
        Acta Ophthalmol. 2019; 97: 491-496
        • Stein LA
        • Ellis FJ.
        Apparent contralateral inferior oblique muscle overaction after unilateral inferior oblique muscle weakening procedures.
        J AAPOS. 1997; 1: 2-7
        • Akar S
        • Gökyiğit B
        • Yilmaz OF.
        Graded anterior transposition of the inferior oblique muscle for V-pattern strabismus.
        J AAPOS. 2012; 16: 286-290
        • Scelfo C
        • Elhusseiny AM
        • Alkharashi M.
        Effect of inferior oblique myectomy on primary position when combined with lateral rectus recession for intermittent exotropia.
        Eur J Ophthalmol. 2022; 32: 559-562
        • Astudillo PP
        • Cotesta M
        • Schofield J
        • Kraft S
        • Mireskandari K.
        The effect of achieving immediate target angle on success of strabismus surgery in children.
        Am J Ophthalmol. 2015; 160: 913-918