Comparison of Surgical Approaches to Inferior Oblique Overaction
Erin G. Sieck, MD; Jennifer L. Patnaik, PhD; Jennifer L. Jung, MD; Jasleen K. Singh, MD
University of Colorado – Anschutz Medical Campus
Introduction: Inferior oblique overaction (IOOA) is a common condition seen by pediatric ophthalmologists, either primary or with other forms of strabismus. Surgery is the primary intervention. The purpose of this study is to compare surgical outcomes of myotomy, anteriorization, myectomy and recession.
Methods: A retrospective chart review of all patients undergoing IOOA correction from July 2010 to March 2017 at the Children’s Hospital of Colorado was performed. Preoperative grading of IOOA (+0.5 to +4.0) was compared to post-operative IOOA (0 to +4.0). Decrease in IOOA was considered a success with resolution (grade 0) of IOOA. Average follow-up was over 9 months for all surgical groups.
Results: There were a total of 296 patients with 408 eyes. Gender and age were similar across surgery types. 95.1% of patients had a decrease in IOOA with recession of the inferior oblique (n=183), while 86.3% decreased to no IOOA. Anteriorization of the inferior oblique (n=127) decreased overactivity in 97.6% of patients with 83.5% improving to zero degree of IOOA. Myotomy of the inferior rectus (n=91) was found to decrease overaction in 98.9% of patients and reduce IOOA to zero in 89.0%. Myectomy (n=7) patients had zero post-operative IOOA in all seven eyes. There was no significant difference between type of surgery and outcome.
Discussion: All four surgical interventions were found to be equally successful in reducing the amount of IOOA.
Conclusion: There is no superior surgical intervention when choosing an approach to IOOA. Myotomy is technically faster and safer as it does not require suturing to the globe.
References: 1. Sanjari MS, Shahraki K, Nekoozadeh S, Tabatabaee SM, Shahraki K, Aghdam KV. Surgical treatment in inferior oblique muscle overaction. J Ophthalmic Vis Res. 2014; 9:291-295.
2. Stager D, Dao LM, Felius J. Uses of the inferior oblique muscle in strabismus surgery. Middle East Afr J Ophthalmol. 2015; 22:292-297