Effect of combining oblique muscle weakening procedures with bimedial rectus recessions on the surgical correction of esotropia

Isaac, Cassiano Rodrigues; Chalita, Maria Regina

doi:10.1016/j.jaapos.2014.10.020

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…The results of our study correspond with a recent report by Isaac and Chalita [17] that showed patients who had undergone oblique weakening surgery in combination with MR recession might require larger MR recession to correct the primary esodeviation. On the other hand, in patients with recurrent or consecutive exodeviation associated with IOOA and DVD, BIOT alone or exotropia surgery (such as MR resection or LR recession) should be performed as appropriate, according to the magnitude of exodeviation.…”

Section: Discussionsupporting

confidence: 92%

A Valid Indication and the Effect of Bilateral Inferior Oblique Transposition on Recurrent or Consecutive Horizontal Deviation in Infantile Strabismus

Kim

2017

Korean J Ophthalmol

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PurposeTo evaluate the effects of bilateral inferior oblique transposition (BIOT) on horizontal deviation from primary position among patients with bilateral dissociated vertical deviation (DVD) associated with inferior oblique overaction (IOOA) in infantile strabismus.MethodsRetrospective chart review was conducted among 19 patients with infantile strabismus. All patients had DVD and IOOA with consecutive or recurrent horizontal deviation and underwent modified BIOT surgery. Patients were divided into three subgroups: patients who underwent BIOT (BIOT group, n = 9) alone, BIOT with medial rectus recession or lateral rectus resection simultaneously (ET BIOT group, n = 6), or BIOT with lateral rectus recession or medial rectus resection simultaneously (XT BIOT group, n = 4). Postoperative angle of horizontal deviation (prism diopter, PD) and corrected magnitude of horizontal deviation (PD) at final visit after surgery were analyzed in each group.ResultsThe mean age was 55.11 ± 21.05 months (range, 32 to 115). The mean follow-up period was 8.68 ± 2.87 months (range, 6 to 18). Preoperative horizontal deviation was 4.23 ± 5.99 PD (range, 0 to 16) in BIOT, −17.33 ± 6.76 PD (range, −30 to −10) in ET BIOT, and 17.50 ± 2.52 PD (range, 14 to 20) in XT BIOT. Esodeviation is represented by negative values. DVD and IOOA were reduced less than +1 in all patients. The corrected amount of horizontal deviation was 3.56 ± 5.18 PD (range, 0 to 16) in BIOT surgery alone and larger in XT BIOT (18.50 ± 3.41 PD) than in ET BIOT (12.33 ± 5.57 PD, p = 0.004).ConclusionsMinimal exodeviation was corrected by BIOT alone. In addition, secondary eso- or exodeviation at great magnitudes should be corrected with proper horizontal muscle surgery along with BIOT.

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Section: Discussionsupporting

confidence: 92%

A Valid Indication and the Effect of Bilateral Inferior Oblique Transposition on Recurrent or Consecutive Horizontal Deviation in Infantile Strabismus

Kim

2017

Korean J Ophthalmol

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“…1,2 Similarly, some studies have focused on the effect of weakening the superior oblique, whose tertiary action is also abduction. [3][4][5] These studies also suggest that a negligible shift in primary position is observed with superior oblique weakening.…”

Section: Introductionmentioning

confidence: 97%

Effect of inferior oblique myectomy on primary position when combined with lateral rectus recession for intermittent exotropia

Scelfo

Elhusseiny

Alkharashi

2021

European Journal of Ophthalmology

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Purpose: To evaluate the surgical success and need for adjustment due to overcorrection in patients who undergo inferior oblique myectomy (IOM) combined with lateral rectus recession (LRc) for intermittent exotropia in the setting of inferior oblique overaction. Methods: A retrospective chart review was conducted of patients with intermittent exotropia who underwent LRc using adjustable sutures alone versus LRc combined with IOM between January 2010 and July 2018 at our institution. Binocular alignment was recorded before and within one week of surgery. Evaluation measures noted were surgical success (defined as distance alignment of ⩽10 prism diopters) and need for postoperative adjustment due to overcorrection. Results: Of 48 patients, 24 underwent LRc alone and 24 underwent LRc combined with IOM; all 48 patients had adjustable sutures. Surgical success was significantly higher in the LRc alone group (91.6%) compared with the LRc with IOM group (62.5%) ( p = 0.036). The need for postoperative adjustment due to overcorrection was also significantly higher in the LRc with IOM group (20.8%) compared with the LRc alone group (0%) ( p = 0.049). Conclusions: In this study, more patients needed adjustment for overcorrection after undergoing LRc combined with IOM versus LRc alone. Since the tertiary action of the inferior oblique is abduction it is possible that, in patients with inferior oblique overaction, surgically weakening the inferior oblique causes more esodeviation and overcorrection. Thus, surgical correction of exotropia and inferior oblique overaction using LRc combined with IOM may lead to overcorrection and increased need for postoperative adjustment.

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“…Combining surgery for esotropia and an overacting IO muscle is often necessary. Previous studies have noted minimal effects of IO surgery on the primary position of gaze, suggesting that this factor doesn't need to be included in planning the surgery for horizontal deviation [5,6]. However, the influence of horizontal surgery on IO dysfunction is not fully understood.…”

Section: Introductionmentioning

confidence: 99%

What to expect from primary inferior oblique overaction after esotropia surgery

Freitas-da-Costa,

Alves,

Santos-Silva

et al. 2023

BMC Ophthalmol

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Background Overelevation 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. Methods The 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. Results One 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). Conclusion Graded 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.

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Effect of combining oblique muscle weakening procedures with bimedial rectus recessions on the surgical correction of esotropia

Cited by 6 publications

References 11 publications

A Valid Indication and the Effect of Bilateral Inferior Oblique Transposition on Recurrent or Consecutive Horizontal Deviation in Infantile Strabismus

A Valid Indication and the Effect of Bilateral Inferior Oblique Transposition on Recurrent or Consecutive Horizontal Deviation in Infantile Strabismus

Effect of inferior oblique myectomy on primary position when combined with lateral rectus recession for intermittent exotropia

What to expect from primary inferior oblique overaction after esotropia surgery

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