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Moon, Kwak, and Kim: Contralateral Inferior Oblique Overaction after Inferior Oblique Recession in Unilateral Moderate Primary Inferior Oblique Overaction
Original Article

J Korean Ophthalmol Soc 2013;54(12):1888-1892.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.12.1888

Contralateral Inferior Oblique Overaction after Inferior Oblique Recession in Unilateral Moderate Primary Inferior Oblique Overaction

Sung Hyuk Moon, MD1, Dong Yub Kwak, MD2, Myung Mi Kim, MD, PhD3,

1Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

2Ulsan Shinsaegae Eye Clinic, Ulsan, Korea

3Department of Ophthalmology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Myung Mi Kim, MD, PhD Department of Ophthalmology, Yeungnam University Medical Center, #170 Hyeonchung-ro, Nam-gu, Daegu 705-703, Korea, Tel: 82-53-620-3441, Fax: 82-53-626-5936, E-mail: mmk@med.yu.ac.kr

Received 24 November 201219 June 2013       Accepted 8 October 2013

Copyright © 2013 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the incidence rate of inferior oblique muscle overaction (IOOA) in the contralateral eye and the effect of inferior oblique (IO) muscle recession of the contralateral eye in the patients who received IO muscle recession for unilateral moderate (+2 or +3) primary IOOA.

Methods

Medical records of 88 patients with unilateral primary IOOA who underwent unilateral IO muscle recession were retrospectively reviewed and observed during a follow-up period of more than 1 year. Graded recession of the IO muscle was performed according to the degree of IOOA. If postoperative IOOA was below +1, the surgery was considered successful. If IOOA in the contralateral eye was more than +2 after surgery, the IOOA was considered to have occurred.

Results

In cases where IOOA was +2 and +3 before the surgery, the success rate was 98.2% and 100%, respectively, showing an overall success rate of 98.8%. The incidence of contralateral IOOA after recession of the unilateral IO muscle was 24.1% in the +2 group and 16.6% in the +3 group with an overall incidence rate of 21.6% and when the IO muscle recession of the contralateral eye was performed, the success rate was 100%.

Conclusions

The incidence of contralateral IOOA was 21.6% after the unilateral IO muscle recession in moderate unilateral primary IOOA. A satisfactory outcome was obtained through an additional IO muscle recession in the contralateral eye.

Keywords: Contralateral inferior oblique muscle overaction, Unilateral inferior oblique muscle recession

References

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Table 1.
Demographics of patients undergoing unilateral inferior oblique recession
Characteristics Values
Total number of patients 88
Male/female (n, %) 41 (46.5) / 47 (53.5)
Age at initial diagnosis (years) 4.3 ± 3.91 (0-31)
Age at surgery (years) 7.0 ± 6.59 (1-33)
Follow-up period (months) 63.5 ± 46.8 (12-199)

Values are presented as mean ± SD.

용하였으며, p-value<0.05일 때 통계적 유의성이 있는 것

Table 2.
Type of coexisting strabismus
Type of strabismus Contralateral IOOA after surgery*
 No. of patients
Occurred Not occurred
Intermittent exotropia 11 51 62
Infantile esotropia 4 5 9
Partially accommodative esotropia 1 6 7
Constant exotropia 1 3 4
Acquired esotropia 1 3 4
Sensory exotropia 1 0 1
No other strabismus 0 1 1

IOOA = overaction of inferior oblique muscle.

* There are no statistically significant differences between occurred group and no occurred group by the Fisher's exact test (p = 0.226).

Table 3.
Results of unilateral inferior oblique recession
Preoperative grading of IOOA No. of eyes Amount of IO recession Success rate*
+2 58/88 (65.9%) 8 mm 57/58 (98.2%)
+3 30/88 (34.1%) 10 mm 30/30 (100%)
Total     87/88 (98.8%)

IOOA = overaction of inferior oblique muscle; No. = number; IO = inferior oblique muscle.

* There are no statistically significant differences between +2 and +3 by the Chi-square test (p = 1.000).

Table 4.
Incidence of postoperative IOOA in contralateral eye
Preoperative grading of IOOA Postoperative IOOA in contralateral eye*
+2 14/58 (24.1%)
+3 5/30 (16.6%)
Total 19/88 (21.6%)

IOOA = overaction of inferior oblique muscle.

* There are no statistically significant differences between +2 and +3 by the Chi-square test (p = 0.419).

Table 5.
Result of postoperative IOOA in contralateral eye
Postoperative grading of IOOA in contralateral eye* Amount of IO recession
 Total
8 mm 10 mm
+2 13/14 (92.9%) 3/5 (60.0%) 16/19 (84.2%)
+3 0/14 (0%) 1/5 (20.0%) 1/19 (5.3%)
+4 1/14 (7.1%) 1/5 (20.0%) 2/19 (10.5%)

IOOA = overaction of inferior oblique muscle.

* There are no statistically significant differences between 8 mm IO recession and 10 mm IO recession by the Fisher's exact test (p = 0.146).

Table 6.
Patients with inferior oblique overaction in contralateral eye after unilateral inferior oblique recession
Case Sex Preop IOOA Preop VD (PD) Age at surgery Laterality Horizontal strabismus Horizontal surgery at 1st surgery 1st surgery Postop IOOA Occurred IOOA in contralateral eye Postop VD (PD) Horizontal surgery at 2nd surgery 2nd surgery in contralateral eye
1 F +3 0 7 OS Constant XT R&R OS IO rec 10 0 +2 10 LR rec OD IO rec 8
2 F +2 4 17 OS Int XT LR rec OU IO rec 8 0 +2 12 MR res OD IO rec 8
3 F +2 0 4 OS Int XT R&R OS IO rec 8 0 +2 14 R&R OD IO rec 8
4 M +2 8 7 OS Int XT R&R OS IO rec 8 0 +2 8 LR rec OD IO rec 8
5 F +2 0 2 OD Inf ET MR rec OU IO rec 8 0 +2 8   IO rec 8
6 M +3 0 1 OD Inf ET MR rec OU IO rec 10 +1 +3 2   IO rec 10
7 M +3 0 1 OD Inf ET MR rec OU IO rec 10 0 +4 25   IO rec 14
8 M +2 0 4 OD Int XT R&R OD IO rec 8 0 +4 0 LR rec OS IO rec 14
9 M +2 0 7 OD Acquired ET MR rec OU IO rec 8 -0.5 +2 4    
10 M +2 0 1 OD Inf ET MR rec OU IO rec 8 0 +2 4    
11 M +2 10 4 OD Int XT LR rec OU IO rec 8 0 +2 8    
12 F +2 0 5 OS Int XT LR rec OU IO rec 8 0 +2 6    
13 F +2 0 5 OS Int XT LR rec OU IO rec 8 0 +2 0    
14 M +2 6 4 OS Int XT R&R OD IO rec 8 0 +2 0 R&R OS  
15 F +2 0 5 OS Int XT R&R OS IO rec 8 0 +2 12 R&R OD  
16 F +2 0 5 OS Int XT R&R OS IO rec 8 0 +2 0    
17 F +3 4 4 OD Int XT R&R OS IO rec 10 0 +2 8    
18 M +2 0 9 OD Pa ET MR rec OU IO rec 8 0 +2 2    
19 F +3 4 5 OS Sensory XT R&R OS IO rec 10 0 +2 0 R&R OD  

IOOA = overaction of inferior oblique muscle; VD = vertical deviation; XT = exotropia; R&R = lateral rectus recession and medial rectus resection; IO rec = recession of inferior oblique muscle; LR = lateral rectus muscle; rec = recession; Int XT = intermittent exotropia; MR = medial rectus muscle resection; Inf ET = infantile esotropia; Pa ET = partially accommodative esotropia.

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