A prospective evaluation of anterior transposition of the inferior oblique muscle, with and without resection, in the treatment of dissociated vertical deviation

Unilateral inferior oblique anterior transposition for dissociated vertical deviation

“…Although the sample size of unilateral IOAT is often small, the results are grouped in the bilateral surgical outcomes, or follow-up is short, one can find evidence of excellent outcomes when the data are carefully inspected. 5,13,[15][16][17]28 IOAT has inherent limitations. Burke et al suggested that patients with DVD Ͼ 15 PD have poor outcomes.…”

“…Some have suggested that unilateral IOAT be avoided to reduce the incidence of a postoperative hypotropia. 6,10,13,14 Successful outcomes have been reported with unilateral IOAT in studies with small sample sizes when inferior oblique overaction coexists with unilateral or asymmetric DVD. 4,5,13,[15][16][17] We have used unilateral IOAT for unilateral or asymmetric DVD, and performed a retrospective review of the charts of consecutive patients to assess the efficacy of this procedure.…”

Anterior transposition vs anterior and nasal transposition of inferior oblique muscle in treatment of dissociated vertical deviation associated with inferior oblique overaction

“…Post-operative hypotropia was a reported complication of ANT procedure (4 cases) in Fard study and was also reported following ATIO in Black, Burke, Bremer and Quinn studies. 5,12,15,23 One case in the current series developed consecutive exotropia of 20 PD. This patient had long-standing infantile ET associated with unilateral DVD and IOOA and the patient had no fusion on worth's four dot test.…”

The pen, the pencil, and the inferior oblique

“…15 It would also explain why Quinn and coworkers showed that a 7 mm resection of the distal portion of the IO muscle prior to anterior transposition was no more effective than standard anterior transposition in controlling dissociated vertical deviation. 16 Small primary position hypotropias occurred in a few instances with or without resection and did not occur in any of the five cases where resection with anterior transposition was performed unilaterally.…”

“…13 In Quinn's study, two of the five patients in the resection group developed worse IO muscle overaction in the contralateral eye after surgery. 16 Limitation to elevation in abduction was more frequent in the resection group. Perhaps anterior transposition decreases the elevation function of the IO muscle while retaining or increasing (with resection or temporal spreading of the insertion) extorsion of the eye.…”