Comparing graded anterior transposition with myectomy in primary inferior oblique overaction – A clinical trial

Abstract

PurposeTo compare the effects of graded anterior transposition with myectomy in primary inferior oblique overaction (IOOA).MethodsIn a randomized clinical trial study, patients entered into two groups: graded anterior transposition (Group 1) and myectomy (Group 2). In the myectomy method, 8 mm of the inferior oblique (lO) muscle was excised in the lower temporal side, and in the graded anterior transposition group, the IO muscle was recessed according to Wright's method. Patients were followed up for at least 1.5 months. IOOA was graded from 0 to +4. Surgical success was defined as reduced IOOA to a grade of +1 or less.ResultsIn a randomized clinical trial study, a total of 30 patients (60 eyes) were included in the study (32 eyes in Group 1 and 28 eyes in Group 2). Pre-operation IOOA was 3.18 ± 0.78 and 3.25 ± 0.70 in Groups 1 and 2, respectively. Mean IOOA in Group 1 and 2 was 0.95 ± 0.24 and 0.40 ± 0.10 at 6 months after the surgery, which means the mean correction of the overaction was statistically significant in both methods (P < 0.001). The success rate in the myectomy procedure was higher than graded recession. The weakening effect was better in higher grades of overaction (P < 0.001). The overall success rate of Groups 1 and 2 was 75% and 96.4%, respectively (P = 0.029).ConclusionsIn both groups, IOOA significantly decreased after the operation. The success rate of the myectomy procedure was found to be significantly higher than graded anterior transposition.

Inferior Oblique Anterior Transposition versus Myectomy for Inferior Oblique Overaction: Systematic Review and Meta Analysis

“…The operation time of the procedures was reported by the Nabie et al 19 who highlighted longer mean operation times in the anterior transposition procedure (6.49 ± 0.91 min) compared with the myectomy group (5.80 ± 0.86 min), showing statistical significance (P = 0.0038).…”

“…Surgical time was a significant outcome highlighted by Nabie et al to be significantly shorter in duration in the myectomy group. 19 Finally, no macular changes were reported in both procedures. The comparison between myectomy and anterior transposition for the treatment of IOOA remains a controversial topic as demonstrated by the included studies.…”

“…Surgical time was a significant outcome highlighted by Nabie et al to be significantly shorter in duration in the myectomy group. 19 Finally, no macular changes were reported in both procedures.…”

“…The comparison between myectomy and anterior transposition for the treatment of IOOA remains a controversial topic as demonstrated by the included studies. [12][13][14][15][16][17][18][19][20][21][22] An RCT conducted by Vodicková et al involving a sample of 82 eyes of 46 individuals who were treated with myectomy (n = 38) or anterior transposition (n = 44) in DVD found no significant difference in postoperative outcomes between both interventions including re-operation rates, a final grade of IOOA and size of DVD. 25 A review of the effect of myectomy (n = 16) and anterior transposition (n = 15) on horizontal deviation by Alshehri and Park of 31 patients have shown no statistically significant difference in the mean difference of horizontal deviation between unilateral myectomy and anterior transposition.…”

“…Table 1 summarises the baseline characteristics of the included studies. [12][13][14][15][16][17][18][19][20][21][22] The majority of the studies were retrospective with a total sample of 728 subjects. The studies were homogenous in the population and design comparing anterior transposition versus myectomy for the treatment of IOOA.…”