Restriction of elevation in abduction after inferior oblique anteriorization

Graded anterior transposition of the inferior oblique muscle for V-pattern strabismus

“…3,5,11,12 Guemes and Wright 4 reported excellent results with graded anterior transposition, with a .90% success rate for mild-to-severe inferior oblique muscle overaction. In this series, 82% of cases with 13 or more overaction showed normal versions, and all of these severe cases showed no more than AE1 inferior oblique muscle dysfunction.…”

“…3 Anteriorization of the posterior fibers of the inferior oblique muscle has produced an unacceptably high incidence rate of postoperative hypotropia and limited elevation. 5,14,15 Stager, 6 Stidham and colleagues, 7 and Kushner 5 have shown the importance of the posterior muscle fibers and the neurovascular bundle in producing Journal of AAPOS Volume 16 Number 3 / June 2012 Akar, G€ okyi git, and Yılmaz limited elevation after anterior transposition of the inferior oblique muscle. Graded anteriorization of the anterior fibers was designed by Wright to reduce the complication of limited elevation.…”

“…In addition, the inferior oblique muscle insertion line is oriented parallel to the axis of the inferior rectus muscle, and the posterior muscle fibers are placed at least 3 mm posterior to the inferior rectus insertion, 4 thus avoiding the J deformity, which produces the antielevation syndrome described by Kushner. 4,5 In some studies, the importance of the posterior muscle fibers and the neurovascular bundle in producing limited elevation after inferior oblique muscle anterior transposition was demonstrated. [5][6][7] reported that the neurofibrovascular bundle acts as an origin for the temporal portion of the inferior oblique muscle when its insertion is anteriorized.…”

“…4,5 In some studies, the importance of the posterior muscle fibers and the neurovascular bundle in producing limited elevation after inferior oblique muscle anterior transposition was demonstrated. [5][6][7] reported that the neurofibrovascular bundle acts as an origin for the temporal portion of the inferior oblique muscle when its insertion is anteriorized. The stiffness of the inferior oblique neurofibrovascular bundle acts as a functional tether, changing the function of the muscle from an elevator to a depressor.…”

Traumatic tear of the inferior rectus muscle treated with inferior oblique anterior transposition

“…Kushner reported that the more distant the insertion of the IO posterior fibers from the lateral extremity of the inferior rectus insertion, the greater the limitation of elevation [13]. He explained this observation on the basis that with increasing distance, these fibers become more stretched (''anti-elevation syndrome'').…”