The Effect of Graded Recession and Anteriorization on Unilateral Superior Oblique Palsy

PURPOSE: We wanted to examine the effect of graded recession and anteriorization of the inferior oblique muscle on patients suffering from unilateral superior oblique palsy. METHODS: Inferior oblique muscle graded recession and anteriorization were performed on twenty-two patients (22 eyes) with unilateral superior oblique palsy. The recession and anteriorization were matched to the degree of inferior oblique overaction and hypertropia. The inferior oblique muscle was attached 4 mm posterior to the temporal border of the inferior rectus muscle in six eyes, 3 mm posterior in five eyes, 2 mm posterior in five eyes, 1 mm posterior in five eyes, and parallel to the temporal border in one eye. RESULTS: The average angle of vertical deviation prior to surgery was 11.3+/-3.9 prism diopters (PD). The total average correction in the angle of vertical deviation after surgery was 10.8+/-3.8 PD. In the parallel group, the average reduction was 14 PD. After surgery, normal inferior oblique muscle action was seen in eighteen of twenty-two eyes (81.8%). CONCLUSIONS: Graded recession and anteriorization of the inferior oblique muscle is thought to be an effective surgical method to treat unilateral superior oblique palsy of less than 15 PD.

Effect of Graded Recession and Anteriorizstion for the Overactin Inferior Oblique Muscle

To investigate the effect of graded recession and anteriorization of the overaction inferior oblique muscle, we performed graded recession and anteriorization of inferior oblique muscle in 34 patients(44 eyes) with dissociated vertical deviation(DVD) and/or inferior oblique overaction(IOOA). By the degree of IOOA, graded recession and anteriorization were done 4mm back and 2mm temporal to inferior rectus insertion in 6 eyes, 4mm back in 11 eyes, 3mm back in 6 eyes, 2mm back in 1 eye, 1mm back in 13 eyes, 0.5mm back in 1 eyes, and 0mm, parrallel in 6 eyes. The amount of graded recession and anteriorization was statistically correlated with the degree of change in IOOA(r=0.82, p<0.05) after surgery. Of the 44 eyes, 33(75%) had normal inferior oblique action after surgery. Of the 6 eyes with abnormal oblique function, 4 eyes had overaction of +1, 1 eye had overaction of +2, 1 eye had underaction of -1, 5 eyes had limitation of elevation in upward gaze which did not show hypotropia in primary position. The unilateral recession and anteriorization caused contralateral IOOA in 1 patient. In conclusion, graded recession and anteriorization of the inferior oblique is effective in the surgical management IOOA and DVD. However, to avoid postoperative limitation of elevation and occurrence of contralateral IOOA, we suggest graded recession and anteriorization be used bilaterally when possible.