ABSTRACT
PURPOSE: To investigate changes in ocular excyclotorsion in patients with inferior oblique overaction (IOOA) according to amount of correction by graded inferior oblique recession and to compare the amount of excyclotorsion between primary IOOA and secondary IOOA. METHODS: This study included 54 eyes of 54 patients who were diagnosed with unilateral IOOA and underwent graded inferior oblique recession. Fundus photographs were taken pre- and postoperatively. The sum of angles of torsion of both eyes was used to analyze changes in excyclotorsion. The angle of excyclotorsion was analyzed using the ImageJ program. RESULTS: Eighteen eyes were grade 2, 24 eyes were grade 3 and 12 eyes were grade 4. Preoperative angle of excyclotorsion was 16.23 ± 5.96° for the patients with grade 2 eyes, 18.83 ± 5.76° for the patients with grade 3 eyes and 29.00 ± 10.23° for the patients with grade 4 eyes. Therefore, as the degree of IOOA increased, the amount of excyclotorsion became larger. There was no statistical significance between grade 2 and grade 3 (p = 0.467), however, there was a statistically significant difference between grade 3 and grade 4 (p < 0.001). Postoperative angle of excyclotorsion was significantly decreased in each group (grade 2: p = 0.020, grade 3: p < 0.001, grade 4: p = 0.041). The amount of surgical recession of inferior oblique muscle showed a positive correlation with a decrease in the angle of excyclotorsion, but was not statistically significant. The amount of excyclotorsion and the decrease of excyclotorsion after surgery were larger in secondary IOOA than in primary IOOA, but were not statistically significant (p = 0.260). CONCLUSIONS: As the preoperative degree of IOOA increased, the amount of correction of excyclotorsion became larger but there is no statistical significance. Correction of IOOA and excylclotorsion is expected after graded inferior oblique recession.
Subject(s)
HumansABSTRACT
PURPOSE: To evaluate the efficacy and prognosis of graded inferior oblique recession in inferior oblique overaction. METHODS: We reviewed the records of 92 patients (184 eyes) who had been diagnosed with inferior oblique overaction and who had undergone an inferior oblique recession in both eyes. All were followed up for a minimum of 1 year postoperatively, and preoperative exclusion criteria included superior oblique palsy, history of vertical rectus muscle surgery, and previously performed inferior oblique muscle surgery. Inferior oblique overaction was graded from +1 (mild overaction) to +4 (severe overaction) and each group had 6 mm, 8 mm, 10 mm, and 14 mm inferior oblique recessions performed, respectively. Cases of postoperative inferior oblique overaction under +1 were considered successful. (In the group initially graded as +1, a postoperative grade of 0 was considered a success.) On the other hand, a grade over +1 was considered a failure. RESULTS: The average postoperative follow-up time was 43.7 months (12~159 months). On final examination, 6-mm inferior oblique recession (5 eyes) resulted in 100% success, 8-mm inferior oblique recession (76 eyes) resulted in a 94.7% success rate, 10-mm inferior oblique recession (97 eyes) resulted in an 87.5% success rate, and 14-mm inferior oblique recession (6 eyes) resulted in a 50% success rate. The overall success rate was 89.7% (165 eyes of the 184 eyes). CONCLUSIONS: Graded inferior oblique recession in patients diagnosed with inferior oblique overaction was an effective procedure with stable, long-term outcomes.