Does inferior oblique recession cause overcorrections in laterally incomitant small hypertropias due to superior oblique palsy?

Abstract

Aim To evaluate the effects of inferior oblique muscle recession (IOR) in cases of laterally incomitant hypertropia <10 prism dioptres (PD) in central gaze thact 2t are clinically consistent with superior oblique palsy (SOP). Methods We retrospectively reviewed patients with SOP and hypertropias <10 PD in central gaze who underwent graded IOR. Primary outcomes were reduction of lateral incomitance and number of overcorrections in central gaze. Results Twenty-five patients were included. Mean follow-up was 13.8 months (range 1.4–66). Mean central gaze hypertropia decreased from 5.6±2.1 to 0.2±1.6 PD (p<0.001). Contralateral gaze hypertropia decreased from 15.9±7.6 to 2.3±3.3 PD (p<0.001). Lateral incomitance (central vs contralateral gaze) was 10.3±6.9 PD preoperatively and 2.0±3.0 PD postoperatively (p<0.001). There were two patients overcorrected in central gaze, and one patient overcorrected in downgaze. One patient necessitated further surgery for overcorrection. Conclusions Although small hypertropias can be treated with prisms or small, adjustable inferior rectus recessions, IOR collapses incomitance without causing much overcorrection. IOR is a reasonable treatment for small, laterally incomitant hypertropia due to SOP.

Surgical treatment of superior oblique palsy: Predictors of outcome

“…Most published studies report favorable outcomes with inferior oblique muscle surgery; consequently, this muscle is the most frequently operated on. [ 6 7 9 10 11 12 ] However, some studies suggest that in significant (>20 prism diopters [pd]) vertical deviation (VD), two or more muscles would need to be operated on to achieve a favorable outcome with a low risk of postsurgical overcorrection. Furthermore, in such cases, the results improve after a second intervention.…”

One Year of Pediatric Ophthalmology and Strabismus Research in Review

“…There were 2 overcorrections in primary position, and only 1 required further surgery. 95 However, in another study, combining superior oblique tuck with inferior oblique recession for larger primary gaze hypertropia results in a high incidence of postoperative Brown syndrome. The authors of recommend inferior oblique recession alone in most cases.…”

Surgical interventions for vertical strabismus in superior oblique palsy

“…However, the majority of people treated for symptomatic superior oblique palsy undergo surgery (Plager 1999), the main goal of which is to reduce the vertical ocular misalignment such that the diplopia or anomalous head position, if present preoperatively, is improved or resolved. Surgical options for hypertropia in superior oblique palsy include: ipsilateral superior oblique tendon plication ("tucking") (Bhola 2005; Durnian 2011); superior oblique tendon resection and advancement (Luton 1998;Wheeler 1934); procedures to weaken the ipsilateral inferior oblique, including recession (Hendler 2013;Parks 1972) In patients symptomatic from excyclotorsion, surgical options include Harada Ito advancement of the anterior portion of the superior oblique tendon (Harada 1964;Nishimura 2002), inferior oblique weakening as listed above, and transposition of vertical recti (Nemoto 2000). We will not include surgical options to address excyclotorsion in this review, which will focus on surgical procedures to address symptomatic hypertropia.…”