Recession Vs Myotomy-Comparative Analysis of Two Surgical Procedures of Weakening Inferior Oblique Muscle Overaction

Abstract

Introduction:Inferior oblique overaction (IOOA) can be primary or secondary, isolated or combined to other types of horizontal deviation, mostly with esotropias. Surgical weakening of IOOA means several techniques like; recession, myotomy, myectomy, anteroposition etc.Goals:we analyzed the effect of inferior oblique muscle surgical weakening comparing two groups of patients with primary hypertropia.Material and methods:In 5-years retrospective study, we observed 33 patients on which we did the surgical procedure of weakening inferior muscle overaction by two methods; recession and myotomy.Results:In total number of 33 patients, there were 57,6% male and 42,4% female patients with average age of 10,6±7,5 (in range of 4–36). There was 33,3% of isolated primary hypertropias, and 66,7% combined with esotropias. At 23 (69,9%) patients the recession surgical procedure was done, and with 10 (30,1%) myotomy. Better effect and binocularity was in 65,2% of patients in recession group which was statistically significant with significance level of p<0,0, χ2=5,705; p=0,021.Conclusion:Comparing of two surgical procedures of weakening inferior oblique muscles overaction, recession is better procedure than myotomy.

Surgical management of primary inferior oblique muscle overaction: a subgroup-specific surgical approach

“…Several surgical methods have been defined to treat IOOA and the decision regarding surgical method is based on the preference and experience of the surgeon, as well as the severity of the IOOA (1,8,9).…”

“…Inferior oblique muscle overaction (IOOA) is a common ocular motility disorder characterized by elevation of the affected eye during adduction and is often seen in conjunction with horizontal strabismus (1,2). IOOA is divided into primary and secondary types according to cause (3).…”

“…The primary type, often bilateral with unknown etiology, has been reported in 72% of congenital esotropic cases, 34% of accommodative esotropic cases, and 32% of intermittent ex-otropic cases (2,4). Secondary IOOA is unilateral and usually arises from palsy of the superior oblique muscle (1,2).…”

“…The primary type of IOAA results in overelevation of the adducted eye, smaller vertical strabismus in the primary gaze, a slight head tilt, and a negative head-tilt test. The secondary type results in paralyzed eye elevation upon adduction, hypertropia in the affected eye, a markedly abnormal head posture, and a positive Bielschowsky test (1,5).…”

Inferior Oblique Muscle Overaction: Clinical Features and Surgical Management

“…Clinical features of primary type include elevation of the eye on adduction, slight vertical deviation in the primary position, minimal head tilt, and a negative Bielschowsky test, whereas the features of secondary type include increased vertical deviation in the primary position, elevation of the paralyzed eye on adduction, marked head tilt, and a positive Bielschowsky test [5, 6].…”