Contralateral Inferior Oblique Muscle Overaction after Unilateral Inferior Oblique Weakening Procedures

Jun Won Jang; Sung Eun Kyung

doi:10.7469/JKOS.2015.56.03.413

Journal List > J Korean Ophthalmol Soc > v.56(3) > 1010221

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Jang and Kyung: Contralateral Inferior Oblique Muscle Overaction after Unilateral Inferior Oblique Weakening Procedures

Original Article

J Korean Ophthalmol Soc 2015;56(3):413-419.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.03.413

Contralateral Inferior Oblique Muscle Overaction after Unilateral Inferior Oblique Weakening Procedures

Jun Won Jang, MD, Sung Eun Kyung, MD, PhD

Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea

￭ Address reprint requests to Sung Eun Kyung, MD, PhD Department of Ophthalmology, Dankook University Hospital, #201 Manghyang-ro, Dongnam-gu, Cheonan 330-715, Korea Tel: 82-41-550-6497, Fax: 82-41-561-0137 E-mail: kseeye@hanmail.net

Received 24 May 20143 September 2014 Accepted 17 February 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.

초록

Purpose:

To investigate the effect of unilateral inferior oblique weakening procedures on contralateral inferior oblique muscle functions and factors that may have an effect on contralateral inferior oblique muscle overaction (IOOA).

Methods:

A retrospective chart review was conducted of medical records of 40 patients who underwent unilateral inferior oblique (IO) muscle weakening procedures from 2007 to 2011 and were observed during a follow-up period of more than 6 months. These patients were composed of primary IOOA (4 patients), secondary IOOA due to superior oblique muscle (SO) palsy (21 patients), secondary IOOA due to inferior rectus muscle palsy (1 patient), and dissociated vertical deviation (DVD) accompanied with IOOA (14 patients). Factors that may have an effect on contralateral IOOA after undergoing the operation were assessed.

Results:

There were 7 patients (17.5%) who had over +2 IOOA after operation. IOOA on contralateral eye was increased from average of +0.00 to average of +0.66 ± 0.14 in 6 months after operation ( p < 0.01). There were no statistically significant differences between preoperative factors and functional changes in contralateral IO muscle.

Conclusions:

There were no statistical factors that may have an effect on contralateral IOOA but the possibility of masked SO palsy before performing unilateral IO weakening procedures should be considered. In patients who have unilateral DVD associated with IOOA or small hypertropia, the contralateral IOOA can be more definite after operation; thus caution should be taken before operation.

Go to :

Keywords: Inferior oblique muscle overaction, Unilateral inferior oblique weakening procedures

References

1. Parks MM, Mitchell PR. Oblique muscle dysfunctions. Tasman W, Jaeger EA, editors. Duane's clinical ophthalmology. Philadelphia: J.B. Lippincott;1994. v. 1:chap. 17.

2. Wright KW. Inferior oblique surgery. Wright KW, editor. Color atlas of ophthalmic surgery, strabismus. Philadelphia: JB Lippincott;1991. p. 173–4.

3. Rosenbaum AL, Santiago AP. Clinical strabismus management: principles and surgical techniques. Philadelphia: W.B. Saunders;1999. p. 449–58.

4. Stein LA, Ellis FJ. Apparent contralateral inferior oblique muscle overaction after unilateral inferior oblique muscle weakening procedures. J AAPOS. 1997; 1:2–7.

5. Raab EL, Costenbader FD. Unilateral surgery for inferior oblique overaction. Arch Ophthalmol. 1973; 90:180–2.

6. Braverman DE, Scott WE. Surgical correction of dissociated vertical deviations. J Pediatr Ophthalmol. 1977; 14:337–42.

7. Scott WE, Sutton VJ, Thalacker JA. Superior rectus recessions for dissociated vertical deviation. Ophthalmology. 1982; 89:317–22.

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

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

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

11. von Noorden GK. Binocular vision and ocular motility: theory and management of strabismus. 5th ed.St. Louis: C.V. Mosby;1995. p. 367–8.

12. Stager DR. The neurofibrovascular bundle of the inferior oblique muscle as the ancillary origin of that muscle. J AAPOS. 1997; 1:216–25.

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

14. Kim SH, Na JH, Cho YA. Inferior oblique transposition onto the equator: the role of the equator in development of contralateral inferior oblique overaction. J Pediatr Ophthalmol Strabismus. 2012; 49:98–102.

15. Helveston EM, Mora JS, Lipsky SN, et al. Surgical treatment of superior oblique palsy. Trans Am Ophthalmol Soc. 1996; 94:315–28. discussion 328-34.

16. Bielschowsky A. Lectures on motor anomalies of the eyes: II. Paralysis of individual eye muscles. Arch Ophthalmol. 1935; 13:33–59.

17. Choi SW, Jung SH, Rah SH. Characteristics and outcome in horizontal strabismus combined with unilateral superior oblique palsy. J Korean Ophthalmol Soc. 2007; 48:418–22.

Go to :

Figure 1.

The patient with masked bilateral superior oblique palsy who underwent inferior oblique recession in the left eye shows right inferior oblique overaction.

undefined

Figure 2.

The patient with superior oblique palsy and 6 prism diopters of hypertropia with 25 prism dipoters of exotropia who received inferior oblique recession and lateral rectus recession in right eye shows mild limitation of elevation in the operated eye (circle) and contralateral IOOA (arrow). IOOA = inferior oblique muscle overaction.

undefined

Figure 3.

The patient who underwent inferior oblique recession in the left eye shows limitation of elevation, elevation in abduction and adduction and prominent inferior oblique overaction in the right eye.

undefined

Figure 4.

The patient with unilateral dissociated vertical deviation who received inferior oblique anteriorization in the left eye 5 years ago shows combined dissociated vertical deviation in the right eye and inferior oblique overaction.

undefined

Table 1.

Preoperative characteristics of patients

Characteristics
No. of patients	40
Sex (M:F)	22:18
Age at surgery (years)	12.60 ± 2.4
Preoperative diagnosis
SOP	21
Primary IOOA	4
DVD with IOOA	14
IR palsy	1
Combined strabismus
Exotropia	30
Esotropia	5
None	5

Values are presented as mean ± SD unless otherwise indicated.

SOP = superior oblique muscle palsy; IOOA = inferior oblique muscle overaction; DVD = dissociated vertical deviation; IR = inferior rectus muscle.

Table 2.

Type of surgery

Type of surgery	No. of patients	Percentage
IO recession only (8 mm)	7	17.5
IO recession only (10 mm)	9	22.5
IO recession (8 mm) + unilateral LR recession	7	17.5
IO recession (10 mm) + unilateral LR recession	7	17.5
IO recession (8 mm) + unilateral MR recession	1	2.5
IO recession (10 mm) + unilateral MR recession	1	2.5
IO recession (8 mm) + bilateral LR recession	4	10
IO recession (8 mm) + bilateral MR resection	1	2.5
IO recession (8 mm) + unilateral LR recession, MR resection	1	2.5
IO anteriorization only	1	2.5
IO anteriorization + unilateral SR recession	1	2.5
Total	40	100

IO = inferior oblique muscle; LR = lateral rectus muscle; MR = medial rectus muscle; SR = superior rectus muscle.

Table 3.

Change of the amount of inferior oblique overaction

	Preoperative	Postoperative (6 months)	Amount of change	p-value (paired t-test)
Operated eye	+1.47 ± 0.11	+0.15 ± 0.06	-1.32 ± 0.10	<0.01
Contralateral eye	+0.00	+0.66 ± 0.14	+0.66 ± 0.14	<0.01

Values are presented as mean ± SD.

Table 4.

Factors that may have an effect on contralateral IOOA after unilateral IO weakening surgery

Factors	Analysis method	p-value
Preoperative diagnosis	Chi-square test	0.613
Preoperative amount of IOOA	Spearman’s rho	0.436
Existence of combined exotropia	Fisher’s exact test	0.623
Existence of head tilt	Fisher’s exact test	0.488
Amount of IO recession (8 mm, 10 mm)	Fisher’s exact test	0.145

IOOA = inferior oblique muscle overaction; IO = inferior oblique muscle.

TOOLS

Similar articles