Korean J Ophthalmol.  2018 Dec;32(6):478-482. 10.3341/kjo.2018.0040.

Horizontal Effects of 10-mm Inferior Oblique Recession versus 14-mm Inferior Oblique Recession

• Kim JM
• Kim US

• KMID: 2427962
• DOI: http://doi.org/10.3341/kjo.2018.0040

Abstract

PURPOSE
The aim of this study was to investigate the quantitative effect of inferior oblique (IO) 10- and 14-mm recession on postoperative horizontal deviation.
METHODS
Patients (22 men and 18 women) who underwent IO recession were divided into two groups for comparison studies: group 1 (10-mm IO recession, 15 patients) and group 2 (14-mm IO recession, 25 patients). Preoperative and postoperative horizontal deviations were measured, and the resulting horizontal deviations from the 10- and 14-mm IO recession surgeries were compared. The effects of superior oblique underaction, IO overaction, and combined exodeviation on postoperative horizontal deviation were analyzed.
RESULTS
Although group 1 did not show a significant horizontal deviation change after surgery (1.9 ± 4.5 prism diopters [PD], p = 0.452), group 2 had a meaningful horizontal change after 14-mm recession (2.2 ± 3.8 PD, p = 0.022). Both groups showed a significant esodrift in horizontal deviation (group 1, p = 0.017; group 2, p = 0.030) in patients with exodeviation over 8 PD. The mean change in horizontal deviation was 6.0 ± 5.4 PD for group 1 and 9.0 ± 5.0 PD for group 2. Although the amount of superior oblique underaction did not affect the extent of change in horizontal deviation, patients with severe IO overaction showed a significant change in horizontal deviation after 14-mm IO recession.
CONCLUSIONS
Fourteen-millimeter IO recession could make a statistically significant change in horizontal deviation after surgery. In addition, esodrift should be considered after IO recession in patients with a preoperative exodeviation greater than 8 PD or severe IO overaction.

Keyword

Strabismus; Superior oblique palsy; Surgical treatment

MeSH Terms

Exotropia
Humans
Jupiter
Male
Strabismus

Figure

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  Fig. 1 (A) Change in horizontal deviation after inferior oblique recession. (B) Change in horizontal deviation after inferior oblique recession in patients with preoperative horizontal deviation greater than 8 prism diopters (PD).

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  Fig. 2 Change in horizontal deviation due to superior oblique underaction (SOUA). (A) Group 1 and (B) group 2 showed no significant change in horizontal deviation after surgery (chi-square test, p = 0.880 and p = 0.794, respectively). Change in horizontal deviation due to inferior oblique overaction (IOOA). (C) Group 1 patients showed no significant change after 10-mm recession (chi-square test, p = 0.725). However, a significant horizontal change was noted in (D) group 2 patients with 4+ IOOA (chi-square test, p = 0.002). PD = prism diopters.

Reference

1. Engel JM. Treatment and diagnosis of congenital fourth nerve palsies: an update. Curr Opin Ophthalmol. 2015; 26:353–356.

2. Taylan Sekeroglu H, Dikmetas O, Sanac AS, et al. Inferior oblique muscle weakening: is it possible to quantify its effects on horizontal deviations? J Ophthalmol. 2012; 2012:813085.

3. Souza-Dias C. Horizontal effect of the surgical weakening of the oblique muscles. Arq Bras Oftalmol. 2011; 74:382.

4. Diamond GR, Parks MM. The effect of superior oblique weakening procedures on primary position horizontal alignment. J Pediatr Ophthalmol Strabismus. 1981; 18:35–38.

5. Jampel RS. The fundamental principle of the action of the oblique ocular muscles. Am J Ophthalmol. 1970; 69:623–638.

6. Stager DR, Parks MM. Inferior oblique weakening procedures. Effect on primary position horizontal alignment. Arch Ophthalmol. 1973; 90:15–16.

7. Khawam E, Scott AB, Jampolsky A. Acquired superior oblique palsy. Diagnosis and management. Arch Ophthalmol. 1967; 77:761–768.

8. Chang BL, Yang SW. Inferior oblique overaction. Korean J Ophthalmol. 1988; 2:77–81.

9. Tommila V, Valle O. Effect of inferior oblique muscle recession on horizontal deviation. Acta Ophthalmol (Copenh). 1968; 46:779–784.

10. Shin JH, Paik HJ. Effect of inferior oblique weakening procedures combined with surgery for intermittent exotropia. J Korean Ophthalmol Soc. 2015; 56:249–253.

11. Guzzinati GC. Effect of surgery of the inferior oblique muscle on horizontal heterotropia. Ann Ottalmol Clin Ocul. 1955; 81:447–454.