Background : To compare surgical outcomes and complications of three inferior oblique
weakening procedures; Inferior Oblique Myectomy (IOM), Inferior Oblique combined
Resection-Anterior Transposition (IORAT) and Inferior Oblique Anterior Transposition
(IOAT) in the management of unilateral Superior Oblique (SO) palsy.
METHODS: Retrospective review of medical records of all patients with unilateral SO
palsy who underwent one of the aforementioned IO weakening procedures at Benha
University hospital was performed. Patients were excluded if surgery was bilateral or
combined with other vertical muscle surgery.Primary outcome parameters were
improvement of Hypertropia (HT) in primary gaze, side gazes, on alternate head turn,
Inferior Oblique Overaction (IOOA), Superior Oblique Underaction (SOUA), correction
of head tilt and postoperative complications.
RESULTS: The review reveals a total of 65 patients with unilateral SO palsy; 54
congenital and 11 acquired, who met the study criteria and were classified into 3 groups;
IOM group (24cases), IORAT group (19cases) and IOAT group (22cases). Compared
with IOM, both IORAT and IOAT induced significant correction of HT in primary
position, ipsilateral gaze, contralateral head tilt and IOOA. IORAT was significantly
more effective than IOAT in correction of HT in ipsilateral gaze and contralateral head
tilt while there was no statistical difference between the three groups in correction of HT
in ipsilateral gaze, contralateral head tilt and SOUA. Postoperative Anti-elevation was
significantly recorded following IORAT (6 cases,31%)than IOAT (3 cases, 13%)and
IOM (one cases, 4%).
3
CONCLUSIONS: The IORAT and IOAT were more superior to IOM in correction of
IOOA and HT in the primary position and some other gaze positions. However,
superiority of IORAT over the other two procedures should be weighed againstits
significant association with postoperative underaction of IO muscle and anti-elevation
syndrome. |
