Background -Weakening of the inferior oblique muscle is the procedure of primary importance in the treatment of patients with superior oblique palsy, Knapp's classes I and III. In this study, the effectiveness of anterior transposition of the inferior oblique muscle in the treatment of these patients was evaluated.
Methods -Twenty three patients with superior oblique palsy, Knapp's classes I and III underwent anterior transposition of the inferior oblique muscle. These patients had 10 to 25 prism diopters (PD) hyperdeviation in primary position. The tip of the disinserted muscle was sutured to the sclera parallel and adjacent to the lateral border of the inferior rectus muscle insertion. The prism and alternate cover test measurements were performed in all cardinal positions of gaze before and six months after surgery. Results -The mean reduction of hyperdeviation measured 14.9 PD in the primary position, 23 PD in adduction, 25.2 PD in elevation and adduction, and 18.1 PD in depression and adduction. There was no hypotropia in the primary position or limitation of upgaze. Postoperative hyperdeviation in the primary position was 5 PD or less in 21 out of 23 patients. Conclusion -The anterior transposition of the inferior oblique muscle is very effective in eliminating hyperdeviation in patients with superior oblique palsy, Knapp's classes I and III. Up to 25 PD of hyperdeviation reduction in the primary position can be achieved. If this type of anterior transposition is used, hypotropia in the primary position or limitation of upgaze will possibly not occur.
Purpose: To evaluate the efficacy of combined resection and anterior transposition of the inferior oblique muscle for the treatment of eyes with a moderate to large amount of dissociated vertical deviation (DVD; 10 or more PD) associated with overaction of the inferior oblique muscle.
Patients and Methods: Surgery was performed on 15 eyes of 9 patients with moderate to large DVD associated with overaciion of the inferior oblique muscle. The inferior oblique muscle was disinserted from the sclera and 4 mm of its distal end was resected. It was transposed to a position 1 mm anterior to the lateral border of the inferior rectus muscle insertion. The prism under cover test was used to measure the DVD. Overaction of the inferior oblique muscle was graded on a 4-point scale of 1+ to 4+. The surgical results were evaluated at 1 month and 1 year after surgery.
Results: Preoperativety, the mean DVD measured 16.6 PD. It had decreased to 1.3 PD 1 month after the operation and to 2.6 PD 1 year after the operation. Before the operation, 5 eyes had 4+ and 10 eyes had 3+ inferior oblique muscle overaction. One year after the operation, only 3 eyes had 1+ inferior oblique muscle overaction. None of the patients developed diplopia or hypotropia in the primary position. Mild limitation of elevation has been noticed in 20% of the eyes.
Conclusion: Combined resection and anterior transposition of the inferior oblique muscle is an effective treatment for moderate to large DVD associated with overaciion of the inferior oblique muscle.
J Pediatr Ophthalmol Strabismus 2002;39:268-272.
Inheritance has an important role in the etiology of comitant strabismus. Consanguineous marriage is a leading factor in birth defects in which inheritance has a role. The aim of this study is to reveal if consanguineous marriage increases the risk of developing comitant strabismus. We included 461 patients who underwent primary surgery for comitant strabismus in Shiraz University Khalili Hospital (Fars province, southern Iran) between years 2003 and 2013 in our study. All the patients were living in Shiraz, Iran. Patients were categorized into the following 4 groups: (1) intermittent or constant exotropia, (2) infantile esotropia, (3) nonaccommodative acquired esotropia, and (4) accommodative acquired esotropia. A total of 421 healthy children who were born in Shiraz, at the same period of time, were also studied as a control group. Presence and type of the consanguineous marriages were evaluated in the parents of the patients and control group by a questionnaire. Mean of inbreeding coefficient (α) was calculated in each group of patients and was compared with those of control group. The proportion of parental first cousin marriage was 37.7 and 23.5 % among patient and control groups. The mean of inbreeding coefficients (α) were 0.0236, 0.0283, 0.0288, and 0.0236 in four groups of the patients, respectively. The mean of inbreeding coefficient was 0.0263 in total patients, which was significantly higher than 0.0164 of control group (T=5.27, df=880, P<0.001).Patients with non-accommodative acquired esotropia had the highest mean of inbreeding coefficient (α) (0.0288). It seems that recessive form of inheritance plays an important role in the etiology of comitant strabismus. Modified screening programs may be needed for earlier detection of strabismus in the offspring of consanguineous couples.
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