The Effect of Inferior Oblique Muscle Transposition in Primary and Secondary Inferior Oblique Muscle Overaction

Ju Sang Kim; Sung Eun Park

doi:10.3341/jkos.2015.56.9.1424

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Kim and Park: The Effect of Inferior Oblique Muscle Transposition in Primary and Secondary Inferior Oblique Muscle Overaction

Original Article

J Korean Ophthalmol Soc 2015;56(9):1424-1431.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.9.1424

The Effect of Inferior Oblique Muscle Transposition in Primary and Secondary Inferior Oblique Muscle Overaction

Ju Sang Kim, M.D., Sung Eun Park, M.D., PhD

Department of Ophthalmology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea

Address reprint requests to Sung Eun Park, MD, PhD Department of Ophthalmology, Eulji General Hospital, #68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea Tel: 82-2-970-8271, Fax: 82-2-970-8272 E-mail: 212010@eulji.ac.kr

∗ This study was presented as a poster at the 112th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 6 February 201511 May 2015 Accepted 10 July 2015

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 evaluate and compare the effect of transposition of inferior oblique muscle in patients with primary inferior oblique muscle overaction and secondary due to superior oblique muscle palsy.

Methods

The present study included 41 patients (53 eyes), who appeared to have primary or secondary inferior oblique muscle overaction due to superior oblique muscle palsy and received transposition of inferior oblique muscle with at least 3 months of fol-low-up. Patients were retrospectively analyzed to compare the effect of correction and its prognosis. Inferior oblique muscle over-action was graded as +1 to +4 according to the severity. Successful surgery was defined as postoperative inferior oblique muscle overaction from 0 to +1 and failure as above +2. Hypertropia in primary gaze was also recorded to evaluate the effect of correction.

Results

Twenty-six (35 eyes) and 15 (18 eyes) patients with primary and secondary inferior oblique muscle overaction due to superior oblique muscle palsy, respectively, received transposition of inferior oblique muscle. Patients with primary inferior obli-que muscle overaction showed correction of 2.1 ± 0.9 with preoperative inferior oblique muscle overaction of 2.0 ± 0.7. Patients with secondary inferior oblique muscle overaction showed a correction of 2.3 ± 0.9 with preoperative value of 2.3 ± 0.8. Each 3.2 ± 4.1 prism diopters (PD) and 6.5 ± 5.3 PD of hypertropia at primary gaze showed correction of 3.0 ± 7.4 PD and 6.3 ± 5.1 PD, respectively, in each group.

Conclusions

Primary and secondary inferior oblique muscle overaction due to superior oblique muscle palsy showed no differ-ence in correction of overaction and hypertropia after transposition of inferior oblique muscle. Except for presence of inferior obli-que muscle underaction, the correction appears effective with good prognosis.

Keywords: Inferior oblique muscle overaction, Superior oblique muscle palsy, Transposition

References

1. Muchnick RS, McCullough DH, Strominger MB. Comparison of anterior transposition and recession of the inferior oblique muscle in unilateral superior oblique paresis. J AAPOS. 1998; 2:340–3.

2. Hong JS, Kim MM. Long-term outcome of graded inferior oblique recession. J Korean Ophthalmol Soc. 2006; 47:127–32.

3. Choi DK, Choi MY. Clinical manifestations of inferior oblique overaction in patients with horizontal strabismus. J Korean Ophthalmol Soc. 2012; 53:1493–9.

4. Paik HJ, Choi JS. Comparison of recession, anterior transposition, and myectomy for inferior oblique overaction. J Korean Ophthalmol Soc. 2006; 47:600–6.

5. Song BY, Park SW, Park YG. The surgical effects of inferior obli-que anteriorization. J Korean Ophthalmol Soc. 2004; 45:995–1000.

6. Stager DR, Weakley DR Jr, Stager D. Anterior transposition of the inferior oblique. Anatomic assessment of the neurovascular bundle. Arch Ophthalmol. 1992; 110:360–2.

7. Guemes A, Wright KW. Effect of graded anterior transposition of the inferior oblique muscle on versions and vertical deviation in primary position. J AAPOS. 1998; 2:201–6.

8. Chang YH, Ma KT, Lee JB, Han SH. Anterior transposition of in-ferior oblique muscle for treatment of unilateral superior oblique muscle palsy with inferior oblique muscle overaction. Yonsei Med J. 2004; 45:609–14.

9. Farvardin M, Nazarpoor S. Anterior transposition of the inferior oblique muscle for treatment of superior oblique palsy. J Pediatr Ophthalmol Strabismus. 2002; 39:100–4.

10. Roh IH, Choi MY. The effect of myectomy on the grading of over-action of the inferior oblique muscle. J Korean Ophthalmol Soc. 2006; 47:437–42.

11. Lee KH, Kyung SE. Chang MH. The effect of minimal amount in-ferior oblique recession in superior oblique palsy. J Korean Ophthalmol Soc. 2009; 50:253–9.

12. Moon SH, Kim MM. The outcome of graded inferior oblique re-cession in the congenital unilateral superior oblique palsy. J Korean Ophthalmol Soc. 2013; 54:1882–7.

13. Min BM, Park JH, Kim SY, Lee SB. Comparison of inferior obli-que muscle weakening by anterior transposition or myectomy: a prospective study of 20 cases. Br J Ophthalmol. 1999; 83:206–8.

14. Parvataneni M, Olitsky SE. Unilateral anterior transposition and resection of the inferior oblique muscle for the treatment of hypertropia. J Pediatr Ophthalmol Strabismus. 2005; 42:163–5.

15. Ghazawy S, Reddy AR, Kipioti A. . Myectomy versus anterior transposition for inferior oblique overaction. J AAPOS. 2007; 11:601–5.

16. Ahn JH, Lee SG. Comparison of inferior oblique myectomy, re-cession, and anterior transposition in unilateral congenital superior oblique palsy. J Korean Ophthalmol Soc. 2010; 51:76–80.

17. Mims JL, Wood RC. Antielevation syndrome after bilateral an-terior transposition of the inferior oblique muscles: incidence and prevention. J AAPOS. 1999; 3:333–6.

18. Cho YA, Kim JH, Kim S. Antielevation syndrome after unilateral anteriorization of the inferior oblique muscle. Korean J Ophthalmol. 2006; 20:118–23.

19. Del Monte MA, Parks MM. Denervation and extirpation of the in-ferior oblique. An improved weakening procedure for marked overaction. Ophthalmology. 1983; 90:1178–85.

Figure 1.

Schematic diagram showing IO placement in four grades (right eye, viewed from below). (A) Grade I: IO place-ment-4 mm posterior and 2 mm lateral to IR insertion. (B) Grade II: IO placement-4 mm posterior to IR insertion. (C) Grade III: IO placement-at IR insertion. (D) Grade IV: IO placement-full anteriorization with ‘J’ deformity. IO = inferior oblique muscle; IR = inferior rectus muscle.

Table 1.

Clinical characteristics of patients classified by IOOA classification

	Group I (1° IOOA)		Group II (2° IOOA-SOP)
	With ET	With XT	With ET	With XT	Without
No. of eyes	7	28	6	9	3
Sex
Male	3	13	5	5	3
Female	4	15	1	4	0
Mean age (years)	4.2 ± 2.0	7.4 ± 5.8	10.3 ± 5.9	7.0 ± 3.5	4.6 ± 1.7
Mean follow-up (months)	28.7 ± 26.9	25.1 ± 28.5	15.2 ± 15.3	14.3 ± 12.5	4.0 ± 1.7
Laterality
Right	3	6	0	4	3
Left	0	8	2	3	0
Both	2	7	2	1	0

Values are presented as mean ± SD unless otherwise indicated. IOOA = inferior oblique overaction; SOP = superior oblique muscle palsy; ET = esotropia; XT = exotropia.

Table 2.

Clinical characteristics of patients classified by surgical methods

	IO transposition	IO transposition	IO transposition	IO transposition
Grade I^∗	Grade II^†	Grade III^‡	Grade IV^§
No. of eyes	4	37	9	3
Sex
Male	3	15	8	3
Female	1	22	1	0
Mean age (years)	9.7 ± 5.2	7.0 ± 5.3	5.8 ± 4.1	8.3 ± 5.8
Mean follow-up (months)	18.0 ± 14.7	22.3 ± 25.7	25.6 ± 26.0	2.3 ± 1.2
Laterality
Right	1	17	1	1
Left	3	10	4	0
Both	0	5	2	1

Values are presented as mean ± SD unless otherwise indicated. IO = inferior oblique.

^∗ IO placement: 4 mm posterior and 2 mm lateral to inferior rectus (IR) insertion;

^† IO placement: 4 mm posterior to IR insertion;

^‡ IO placement: at IR insertion;

^§ IO placement: full anteriorization with ‘J’ deformity.

Table 3.

Change of average amount of IOOA^∗ and hypertropia^† (at primary position) classified by IOOA classification

Classification of IOOA	Amount of IOOA/hypertropia (Δ, PD)			Amount of IOOA/hypertropia (Δ, PD) orrection
Classification of IOOA	Preop.	Postop. (3 months)	Postop. (12 months)	Amount of IOOA/hypertropia (Δ, PD) orrection
Group I (1° IOOA)
With esotropia (n = 7)	2.3 ± 0.8	0.0 ± 1.0	-0.5 ± 1.0^‡	2.4 ± 1.1
2.3 ± 2.9	0.4 ± 6.7	0.3 ± 3.7	0.0 ± 6.5
With exotropia (n = 28)	2.0 ± 0.73.4 ± 4.4	0.1 ± 0.8-0.1 ± 5.0^§	-0.1 ± 0.5^‡-1.5 ± 3.2^§	2.0 ± 0.83.8 ± 7.6
Unilateral (n = 17)	1.8 ± 0.6	-0.2 ± 0.7^‡	-0.4 ± 0.7^‡	2.1 ± 1.0
5.0 ± 4.5	-1.8 ± 4.6^§	-2.0 ± 3.5^§	6.6 ± 5.7
Bilateral (n = 9)	2.2 ± 0.81.4 ± 2.9	0.3 ± 0.71.7 ± 5.3	0.1 ± 0.3-0.1 ± 2.8^§	2.0 ± 0.8-0.3 ± 7.4^§
Total (n = 35)	2.0 ± 0.7^∏	0.1 ± 0.7	-0.2 ± 0.6^‡,**	2.1 ± 0.9^‡‡
3.2 ± 4.1^#	-0.1 ± 5.2^§	-1.1 ± 3.2^§,††	3.0 ± 7.4^§§
Group II (2° IOOA-SOP)
With esotropia (n = 6)	2.5 ± 0.8	0.7 ± 1.2	0.3 ± 0.4	1.9 ± 1.3
5.5 ± 6.9	1.0 ± 2.4	0.0 ± 0.0	4.5 ± 5.7
With exotropia (n = 9)	2.1 ± 0.6	-0.4 ± 0.5^‡	-0.2 ± 0.4^‡	2.4 ± 0.6
8.2 ± 4.2	-0.1 ± 2.3^§	0.6 ± 1.3	8.4 ± 4.2
Without (n = 3)	2.7 ± 1.2	0.0 ± 0.0	-	2.7 ± 1.2
2.0 ± 2.8	0.0 ± 0.0	-	2.0 ± 2.8
Unilateral (n = 12)	2.0 ± 0.7	-0.3 ± 0.5^‡	-0.3 ± 0.6^‡	2.4 ± 0.7
7.9 ± 4.4	0.4 ± 2.6	1.0 ± 1.7	7.5 ± 4.0
Bilateral (n = 3)	2.8 ± 0.8	0.8 ± 1.1	0.1 ± 0.3	2.1 ± 1.4
4.0 ± 6.3	0.0 ± 0.0	0.0 ± 0.0	4.0 ± 6.3
Total (n = 18)	2.3 ± 0.8^∏	0.1 ± 0.9	-0.1 ± 0.4^‡,**	2.3 ± 0.9^‡‡
6.5 ± 5.3^#	0.3 ± 2.1	0.4 ± 1.1^††	6.3 ± 5.1^§§

Values are presented as mean ± SD. IOOA = inferior oblique overaction; PD = prism diopter; Preop. = preoperation; Postop. = postoperation; SOP = superior oblique muscle palsy.

^∗ Amount of IOOA classified by Del Monte and Parks¹⁹;

^† Amount of hypertropia at primary position in prism diopters;

^‡ Minus stands for in-ferior oblique (IO) underaction;

^§ Minus stands for amount of ipsilateral hypotropia;

^∏ Preop. amount of IOOA between Group I and II ( p = 0.175);

^# Preop. amount of hypertropia between Group I and II ( p = 0.026);

^∗∗ Postop. (12 months) amount of IOOA between Group I and II ( p = 0.900);

^†† Postop. (12 months) amount of hypertropia between Group I and II ( p = 0.171);

^‡‡ Amount of IOOA correction between Group I and II ( p = 0.331);

^§§ Amount of hypertropia correction between Group I and II ( p = 0.093).

Table 4.

Change of average amount of IOOA^∗ and hypertropia^† (at primary position) in each surgical type classified by IOOA classi-fication

Classification of IOOA	IO trans amount of I			IO tra amount
Classification of IOOA	Preop.	Postop.	Postop.	Preop.	Postop.	Postop.
Preop.	(3 months)	(12 months)	Preop.	(3 months)	(12 months)
Group I (1° IOOA)
With esotropia (n = 7)	2.0 ± 0.7	-0.2 ± 1.1^‡	-0.7 ± 1.2^‡	3.0 ± 0.0	0.5 ± 0.7	0.0 ± 0.0
	3.2 ± 2.9	0.6 ± 8.1	-1.3 ± 2.3^§	0.0 ± 0.0	0.0 ± 0.0	5.0 ± 0.0
With exotropia (n = 28)	1.7 ± 0.4	0.0 ± 0.6	-0.2 ± 0.4^‡	3.2 ± 0.4	0.2 ± 1.1	0.5 ± 0.7
	3.1 ± 3.8	-0.5 ± 4.7^§	-1.7 ± 3.4^§	4.4 ± 7.0	1.4 ± 6.3	0.0 ± 0.0
Total (n = 35)^#	1.8 ± 0.5	-0.1 ± 0.7^‡	-0.3 ± 0.6^‡	3.1 ± 0.4	0.3 ± 1.0	0.3 ± 0.6
	3.2 ± 3.6	-0.3 ± 5.3^§	-1.6 ± 3.1^§	3.1 ± 6.1	1.0 ± 5.2	1.7 ± 2.9
Group II (2° IOOA-SOP)
With esotropia (n = 6)	2.0 ± 0.0	0.5 ± 1.3	0.0 ± 0.0	3.5 ± 0.7	1.0 ± 1.4	0.5 ± 0.0
	4.8 ± 6.6	1.5 ± 3.0	0.0 ± 0.0	7.0 ± 10.0	0.0 ± 0.0	0.0 ± 0.0
With exotropia (n = 9)	1.9 ± 0.49.1 ± 3.2	-0.4 ± 0.6^‡-0.1 ± 2.6^§	-0.3 ± 0.6^‡1.0 ± 1.7	3.0 ± 0.05.0 ± 7.1	-0.3 ± 0.4^‡0.0 ± 0.0	0.0 ± 0.00.0 ± 0.0
Without (n = 3)	2.0 ± 0.0	0.0 ± 0.0	-	4.0 ± 0.0	0.0 ± 0.0	-
	2.0 ± 2.8	0.0 ± 0.0	-	-	0.0 ± 0.0	-
Total (n = 18)^#	1.9 ± 0.3	-0.1 ± 0.9^‡	-0.3 ± 0.5^‡	3.4 ± 0.5	0.3 ± 1.0	0.2 ± 0.3
	6.7 ± 5.0	0.4 ± 2.5	0.8 ± 1.5	6.0 ± 7.1	0.0 ± 0.0	0.0 ± 0.0

Values are presented as mean ± SD.

IOOA = inferior oblique overaction; IO = inferior oblique; PD = prism diopter; Preop. = preoperation; Postop. = postoperation; SOP = superior oblique muscle palsy.

^∗ Amount of IOOA classified by Del Monte and Parks¹⁹;

^† Amount of hypertropia at primary position in prism diopters;

^‡ Minus stands for IO underaction;

^§ Minus stands for amount of ipsilateral hypotropia;

^∏ Grade I: IO placement: 4 mm posterior and 2 mm lateral to inferior rectus (IR) insertion. Grade II: IO placement: 4 mm posterior to IR insertion. Grade III: IO placement: At IR insertion. Grade IV: IO placement: full anteriorization with ‘J’ deformity;

^# Total: Number of eyes in IO transposition Grade I + II and IO transposition Grade III + IV.

Table 5.

Success rate of correction in each amount of IOOA^∗

Preop. IOOA	Postop. IOOA					Success^‡ rate (%)
Preop. IOOA	Underaction^†(<0)	Excellent (0)	Good (+1)	Fair (+2)	Poor (>+2)	Success^‡ rate (%)
+1 (n = 10)	2	8	0	0	0	80.0
Group I (1° IOOA) (n = 9)	1	8	0	0	0	88.9
Group II (2° IOOA-SOP) (n = 1)	1	0	0	0	0	0.0
+2 (n = 30)	6	21	1	2	0	73.3
Group I (1° IOOA) (n = 18)	3	13	1	1	0	77.8
Group II (2° IOOA-SOP) (n = 12)	3	8	0	1	0	66.7
+3 (n = 10)	1	7	1	1	0	80.0
Group I (1° IOOA) (n = 7)	1	5	1	0	0	85.7
Group II (2° IOOA-SOP) (n = 3)	0	2	0	1	0	66.7
+4 (n = 3)	0	2	0	1	0	66.7
Group I (1° IOOA) (n = 1)	0	0	0	1	0	0.0
Group II (2° IOOA-SOP) (n = 2)	0	2	0	0	0	100
Total (n = 53)	9	38	2	4	0	75.5
Group I (1° IOOA) (n = 35)	5	26	2	2	0	80.0^§
Group II (2° IOOA-SOP) (n = 18)	4	12	0	2	0	66.7^§

IOOA = inferior oblique overaction; Preop. = preoperation; Postop. = postoperation; SOP = superior oblique muscle palsy.

^∗ Amount of IOOA classified by Del Monte and Parks¹⁹;

^† IOOA underaction recorded as minus value;

^‡ Amount of postoperative IOOA included between excellent (0) and good (+1);

^§ Success rate between Group I and II ( p = 0.290).

Table 6.

Success rate of correction in each amount of hypertropia^∗

Preop. hypertropia (Δ, PD)	Postop. hypertropia (Δ, PD)				Success^‡ rate (%)
Preop. hypertropia (Δ, PD)	Ipsilateral hypotropia^†(<0 Δ, PD)	Excellent (0-3 Δ, PD)^†	Good (4-7 Δ, PD)	Poor (≥8 Δ, PD)	Success^‡ rate (%)
1-10 (n = 46)	8	33	2	3	76.1
Group (1° IOOA) (n = 33)	7	21	2	3	69.7
Group II (2° IOOA-SOP) (n = 13)	1	12	0	0	92.3
11-20 (n = 7)	1	4	2	0	85.7
Group (1° IOOA) (n = 2)	1	0	1	0	50.0
Group II (2° IOOA-SOP) (n = 5)	0	4	1	0	100
Total (n = 53)	9	37	4	3	77.4
Group (1° IOOA) (n = 35)	8	21	3	3	68.6^§
Group II (2° IOOA-SOP) (n = 18)	1	16	1	0	94.4^§

Preop. = preoperation; PD = prism diopter; Postop. = postoperation; IOOA = inferior oblique overaction; SOP = superior oblique muscle palsy.

^∗ Amount of hypertropia at primary gaze in prism diopters;

^† Amount of hypotropia on ipsilateral side recorded as minus value;

^‡ Amount of post-operative hypertropia included between excellent (0-3 Δ, PD) and good (4-7 Δ, PD);

^§ Success rate between Group I and II ( p = 0.035).

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