Transposición del vientre del oblicuo inferior sin desinserción en el tratamiento de la hipertropia en aducción / Transposition of the inferior oblique muscle belly without disinsertion for overshoot in adduction treatment

Propósito Analizar la eficacia y la seguridad de la transposición del oblicuo inferior con miopexia en pacientes con hiperfunción primaria o secundaria del oblicuo inferior leve-moderada, con o sin diplopía. Método Estudio observacional retrospectivo de 12 pacientes tratados con dicha técnica entre octubre de 2018 y septiembre de 2021. Se suturó el oblicuo inferior a esclera a 5mm posterior a la inserción temporal del recto inferior. Todos tenían desviación vertical de pequeño ángulo (media ±DE: 4,42±1,62) en posición primaria (≤6 dioptrías prismáticas [dp]), hipertropia en aducción leve-moderada y 10 tenían diplopía. Los diagnósticos fueron: paresia del IVnervio (9), DVD (1) e hipertropia en aducción unilateral (2). De los 12 casos, 7 presentaban tortícolis, 2 torsión subjetiva y 2 torsión objetiva. Resultados La edad media de la muestra fue 46,86±25,1 años (50% hombres). De los 10 casos con diplopía, en 9 se resolvió. La desviación vertical media final en mirada al frente fue: 1,5dp ±2,93 (p=0,001). De 7 casos con hipertropia en aducción leve, en 3 desapareció y 4 quedaron igual. De 5 casos con hipertropia en aducción moderada, 2 mejoraron a leves y en 3 desapareció. El tortícolis se resolvió en 5 casos, y en otros 2 mejoró. El tiempo de seguimiento medio fue de 14,08±8,05 meses. No se registraron hipercorrecciones. Conclusiones La transposición del oblicuo inferior con miopexia es una nueva técnica eficaz y segura en pacientes con leve-moderada hipertropia en aducción e hipertropia de pequeño ángulo, con o sin diplopía (AU)

Purpose To evaluate the efficacy and safety of inferior oblique muscle transposition and myopexy in patients with mild/moderate inferior oblique muscle overaction, with or without diplopia. Method We retrospectively analysed data for the 12 patients who underwent the technique. Data were collected from October 2018 to September 2021. Surgery was performed by suturing the inferior oblique belly to the sclera at 5mm posterior to the temporal end of the inferior rectus. All 12 patients had mild hypertropia (≤6 prism diopters [pd]) in primary position and mild/moderate inferior oblique overaction. Mean preoperative hypertropia was 4.42pd ±1.62. Diplopia was recorded in 10 cases. The diagnoses were fourth nerve paresis (9), unilateral primary inferior oblique overaction (2) and dissociated vertical deviation (1). Torticollis was observed in 7 cases, 2 had subjective torsion and 2 objective torsion. Results Mean age was 46.86±25.1 years (50%: men). Diplopia resolved in 9 of the 10 cases. The mean final vertical deviation was 1.5±2.93 (P=.001) pd in straight gaze. Of 7 mild overshoot in adduction, it disappeared in 3 and 4 remained the same. Of 5 moderate overshoot in adduction, 2 improved to mild and 3 disappeared. Torticollis was eliminated in 5 patients and improved in another 2. Mean time from surgery was 14.08±8.05 months. There were no overcorrections Conclusions Inferior oblique muscle transposition with myopexy is a safe and effective procedure in patients with mild-to-moderate inferior oblique muscle overaction and small-angle hypertropia, with or without diplopia (AU)

Transposition of the inferior oblique muscle belly without disinsertion for overshoot in adduction treatment.

PURPOSE: To evaluate the efficacy and safety of inferior oblique muscle transposition and myopexy in patients with mild/moderate inferior oblique muscle overaction, with or without diplopia. METHOD: We retrospectively analysed data for the 12 patients who underwent the technique. Data were collected from October 2018 to September 2021. Surgery was performed by suturing the inferior oblique belly to the sclera at 5 mm posterior to the temporal end of the inferior rectus. All 12 patients had mild hypertropia (≤6 prism diopters [pd]) in primary position and mild/moderate inferior oblique overaction. Mean preoperative hypertropia was 4.42 pd ±â€¯1.62. Diplopia was recorded in 10 cases. The diagnoses were fourth nerve paresis (9), unilateral primary inferior oblique overaction (2) and dissociated vertical deviation (1). Torticollis was observed in 7 cases, 2 had subjective torsion and 2 objective torsion. RESULTS: Mean age was 46.86 ±â€¯25.1 years (50%: men). Diplopia resolved in 9 of the 10 cases. The mean final vertical deviation was 1.5 ±â€¯2.93 (p = 0.001) pd in straight gaze. Of 7 mild overshoot in adduction, it disappeared in 3 and 4 remained the same. Of 5 moderate overshoot in adduction, 2 improved to mild and 3 disappeared. Torticollis was eliminated in 5 patients and improved in another 2. Mean time from surgery was 14.08 ±â€¯8.05 months. There were no overcorrections. CONCLUSIONS: Inferior oblique muscle transposition with myopexy is a safe and effective procedure in patients with mild-to-moderate inferior oblique muscle overaction and small-angle hypertropia, with or without diplopia.

Inferior oblique belly transposition in the treatment of mild inferior oblique overaction with small angle vertical strabismus / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To observe the effect of inferior oblique belly transposition(IOBT)in unilateral mild inferior oblique overaction with small angle vertical stabismus.<p>METHODS: The data of patients who underwent IOBT in our hospital from September 2019 to August 2021 were analyzed retrospectively. Inclusion criteria targeted patients with mild inferior oblique overaction(2+ and below)and small angle incomitant vertical strabismus(4-9PD). The horizontal deviation and vertical deviation in both primary and lateral gazes were measured, and the degree of inferior oblique overaction and fovea-disc angle(FDA)were also evaluated preoperatively and postoperatively.<p>RESULTS: A total of 16 cases(16 eyes)were included, aged 4-39 years. One case was 5a postoperative congenital esotropia with secondary unilateral inferior oblique overaction by mild superior oblique palsy, whereas 15 patients had monocular primary inferior oblique overaction with horizontal strabismus. The follow-up was 3-6mo. The mean improvement of inferior oblique overaction was 2.00(1.25, 2.00)grade from +2.00(2.00, 2.00)preoperatively to 0.00(0.00, 0.00)postoperatively, the difference was statistically significant(<i>Z</i>=-3.70, <i>P</i><0.001). The horizontal strabismus decreased from 69.13±25.86PD preoperatively to 2.75±2.59PD postoperatively(<i>t</i>= 9.929, <i>P</i><0.001). The vertical strabismus in the primary position decreased from preoperative 7.44±1.32PD to 1.00±1.21PD postoperatively(<i>t</i>=22.335, <i>P</i><0.001), mean corrected hypertropia 6.44±1.15PD, and vertical strabismus in lateral gazes decreased from preoperative 12.44±2.73PD to 3.00±2.13PD postoperatively, mean corrected hypertropia 9.44±2.73PD, these differences were statistically significant(<i>t</i>=13.819, <i>P</i><0.001). The FDA decreased from -8.85°±6.53° preoperatively to -6.49°±7.01° postoperatively, the difference was statistically significant(<i>t</i>=-2.384, <i>P</i><0.001), with a mean reduction of 2.36°. No postoperative complications such as postoperative overcorrection or inferior oblique underaction were observed.<p>CONCLUSION:IOBT is safe and effective in correcting unilateral mild inferior oblique overaction with small angle vertical strabismus.

Inferior oblique muscle belly transposition and myopexy for diplopia.

To evaluate the outcomes of and review the indications for Inferior oblique muscle belly transposition in adults with diplopia and small-angle hypertropia associated with mild or moderate upshoot in adduction. We retrospectively analyzed data for the six patients who underwent the technique. Surgery was performed by suturing the inferior oblique belly to the sclera at 5 mm posterior to the temporal pole of the inferior rectus. Data were collected from October 2018 to April 2020. All six patients had diplopia and mild hypertropia (≤6 prism diopters [pd]) in primary position. Mean preoperative hypertropia was 4.17 pd (range, 2-6 pd). Mean age was 51 ± 28.71 years. The diagnoses were fourth nerve paresis (5) and dissociated vertical deviation (1). All patients had mild/moderate upshoot in adduction. Torticollis was observed in four cases. Diplopia resolved in 5 of the 6 cases. The mean final vertical deviation was 2 pd in straight gaze. Torticollis was eliminated in 2 patients and improved in another 2. The upshoot in adduction was totally eliminated in the six patients. Transitory mild limitation of elevation in adduction was observed in two patients during the first week after surgery. No ocular torsion was diagnosed after surgery. Mean time from surgery was 11.5 months. No overcorrections were recorded. Inferior oblique muscle belly transposition with myopexy is a good alternative procedure in patients with diplopia associated with mild-to-moderate upshoot in adduction and small-angle hypertropia.