Primary Inferior Oblique Overaction in Congenital Esotropia, Accommodative Esotropia, and Intermittent Exotropia

doi:10.1016/S0161-6420(89)32774-6

Ophthalmology

Volume 96, Issue 7, July 1989, Pages 950-957

https://doi.org/10.1016/S0161-6420(89)32774-6 Get rights and content

Abstract

A statistical analysis of the onset and natural history of primary inferior oblique eye muscle overaction (IOOA) was conducted using the records of 456 strabismus patients. With 5 years or more of follow-up, IOOA developed in 72% of congenital esotropes (CETs), 34% of accommodative esotropes (AETs), and 32% of intermittent exotropes (X[T]s) at an average age of 3.6, 5.2, and 5.2 years, respectively. Incidence of IOOA was positively related to the number of horizontal surgeries in CETs but not in AETs or X(T)s. Incidence was not related to age of onset of strabismus, time from onset of strabismus to surgery, age at first surgery, or decompensation of ocular alignment. Mild IOOA did revert to normal in 12 patients after only horizontal surgery. The association of IOOA with dissociated vertical deviation, as well as symmetry, range of age of detection, and recurrence after surgery are also explored.

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Cited by (75)

Efficacy of inferior oblique belly transposition combined with inferior oblique recession for asymmetric inferior oblique overaction
2024, Canadian Journal of Ophthalmology
Citation Excerpt :
And none of the patients exhibited overcorrection of IO function or secondary A pattern. IOOA occurred in two-thirds of congenital esotropia, one-third of accommodative esotropia, and one-third of intermittent exotropia approximately.3,7 The role of IOOA in the etiology of noticeable hypertropia and V pattern was established.
To evaluate the efficacy of inferior oblique belly transposition (IOBT) combined with inferior oblique (IO) recession in treating bilateral asymmetric inferior oblique overaction (IOOA).
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.
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).
IOBT combined with IO recession is effective and safe in eliminating hypertropia, V pattern, and extorsion with bilateral asymmetric IOOA.
Évaluer l'efficacité de la transposition du ventre de l'oblique inférieur (IOBT) associée à la récession de l'oblique inférieur (OI) pour la correction d'une hyperaction asymétrique bilatérale de l'oblique inférieur (IOOA).
Analyse rétrospective des données de 14 patients qui ont subi une IOBT du côté où l'IOOA asymétrique bilatérale était légère et une récession de l'OI du côté où l'IOOA était grave. On a examiné les principaux résultats chirurgicaux obtenus, dont la correction de l'IOOA, de l'hypertropie, de la déviation horizontale, de l'incomitance V et de l'angle de l'axe disque optique-fovéa.
La valeur préopératoire (+1,86 ± 0,53) de l'IOOA du côté le moins atteint est passée à +0,07 ± 0,27 (p < 0,001) après l'IOBT; du côté le plus atteint, l'IOOA est passée de +3,14 ± 0,53 à +0,14 ± 0,36 après la récession de l'OI (p < 0,001). La déviation verticale en position primaire en vision de loin est passée de 8,43 ± 4,05 DP à 1,21 ± 1,48 DP après l'intervention (p < 0,001). L'incomitance V moyenne se chiffrait à 25,00 ± 11,62 DP avant l'intervention et à 3,18 ± 2,18 DP après cette dernière (p < 0,001). L'angle de l'axe disque optique-fovéa moyen est passé de –10,47 ± 5,85 degrés à –7,82 ± 6,42 degrés (p = 0,023) du côté où a été réalisée l'IOBT, et de –11,05 ± 5,14 degrés à –6,09 ± 4,52 degrés (p = 0,001) du côté soumis à la récession de l'OI. Le taux de réussite global était de 71,4 % (10 patients sur 14).
L'association d'une IOBT à une récession de l'OI est une technique efficace et sûre pour éliminer l'hypertropie, l'incomitance V et l'extorsion en présence d'IOOA asymétrique bilatérale.
Inferior oblique retro-equatorial myopexy: An alternative weakening
2020, Archivos de la Sociedad Espanola de Oftalmologia
Describir una alternativa quirúrgica para tratar la hiperacción del oblicuo inferior y presentar los primeros resultados con dicha técnica.
Un total de 6 ojos consecutivos de 6 pacientes con hiperacción primaria o secundaria del oblicuo inferior se sometieron a una operación de miopexia retroecuatorial del oblicuo inferior bajo anestesia general. Los resultados primarios medidos fueron la desviación vertical postoperatoria en el campo de acción del músculo oblicuo inferior y las complicaciones quirúrgicas intraoperatorias y postoperatorias. Los resultados finales se evaluaron después de 6 meses de cirugía.
La muestra de pacientes consistió en 3 niñas y 3 niños de entre 3 y 7 años. La media de la hiperacción del oblicuo inferior preoperatoria fue 34 ± 4,6°, equivalente a 3+. La hiperacción del oblicuo inferior se redujo en todos los pacientes, siendo la media de reducción de 28 ± 1,98° y la desviación postoperatoria media de 6 ± 2,84°. Cuatro de 6 ojos obtuvieron un éxito total, y solo un caso quedó sin corregir. No se produjeron complicaciones intraoperatorias o postoperatorias.
La miopexia retroecuatorial del músculo oblicuo inferior es un enfoque quirúrgico alternativo para la hiperacción del oblicuo inferior. Es una técnica eficiente, segura y reversible que podría usarse en casos de hiperacción del oblicuo inferior entre 2+ y 3+.
To describe an alternative surgical approach to treat inferior oblique overaction, and report the first results of this technique.
A total of 6 consecutive eyes of 6 patients with primary or secondary inferior oblique overaction underwent inferior oblique retro-equatorial myopexy under general anaesthesia. The primary outcomes measured were the postoperative vertical deviation in the field of action of the inferior oblique muscle, and the intra- and postoperative surgical complications. Final results were evaluated at six-months after surgery.
The patient population consisted of 3 girls and 3 boys aged between 4 and 7 years old. The mean preoperative inferior oblique overaction was 34° ± 4.6°, equivalent to 3+. Inferior oblique overaction was reduced in all patients with a mean reduction of 28° ± 1.98°, and the mean postoperative deviation was 6° ± 2.84°. Total success was achieved in four out of six eyes, and only one case remained under-corrected. No intra- or postoperative complications were reported.
Inferior oblique retro-equatorial myopexy is an alternative surgical approach for inferior oblique overaction. It is an efficient, safe, and reversible technique that could be used in cases of inferior oblique overaction between 2+ to 3+.
Changes in ocular extorsion after horizontal muscle surgery in patients with intermittent exotropia coexisting with hypertropia and mild inferior oblique overaction
2024, PLoS ONE
What to expect from primary inferior oblique overaction after esotropia surgery: Primary inferior oblique overaction in esotropia
2023, BMC Ophthalmology
Clinical profile of childhood exotropia in a tertiary eye care center in North India
2023, Indian Journal of Ophthalmology
Evaluation of graded recession of inferior oblique muscle for correction of different grades of V-pattern strabismus
2023, BMC Ophthalmology

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⁺: Presented at the American Academy of Ophthalmology Annual Meeting, Las Vegas, October 1988.

⁺⁺: The opinions expressed herein are those of the authors and are not official opinions of the Department of the Navy.

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Primary Inferior Oblique Overaction in Congenital Esotropia, Accommodative Esotropia, and Intermittent Exotropia+,++

Abstract

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Oblique muscle dysfunctions