Comparative study of unilateral versus bilateral inferior oblique recession/anteriorization in unilateral inferior oblique overaction

Eur J Ophthalmol. 2018 May;28(3):272-278. doi: 10.5301/ejo.5001062. Epub 2017 Oct 16.

Abstract

Purpose: To compare the effect of, and the rate of subsequent development of iatrogenic antielevation syndrome after, unilateral versus bilateral inferior oblique graded recession-anteriorization to treat unilateral inferior oblique overaction.

Methods: Thirty-four patients with unilateral inferior oblique overaction were included in a randomized prospective study. Patients were equally divided into 2 groups. Group UNI underwent unilateral, group BI bilateral, inferior oblique graded recession-anteriorization. A successful outcome was defined as orthotropia, or within 2 ∆ of a residual hypertropia, in the absence of signs of antielevation syndrome, residual inferior oblique overaction, V-pattern, dissociated vertical deviation, or ocular torticollis.

Results: A successful outcome was achieved in 11 (64.7%) and 13 (76.5%) patients in groups UNI and BI, respectively (p = 0.452). Antielevation syndrome was diagnosed as the cause of surgical failure in 6 (35.3%) and 2 (11.8%) patients, in groups UNI and BI, respectively (p = 0.106). The cause of surgical failure in the other 2 patients in group BI was due to persistence of ocular torticollis and hypertropia in a patient with superior oblique palsy and a residual V-pattern and hypertropia in the other patient.

Conclusions: The differences between unilateral and bilateral inferior oblique graded recession-anteriorization are insignificant. Unilateral surgery has a higher tendency for the subsequent development of antielevation syndrome. Bilateral surgery may still become complicated by antielevation syndrome, although at a lower rate. In addition, bilateral surgery had a higher rate of undercorrection. Further studies on a larger sample are encouraged.

Keywords: Antielevation syndrome; Bilateral surgery; Inferior oblique graded recession-anteriorization; Inferior oblique overaction; Unilateral surgery.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Male
  • Ocular Motility Disorders / physiopathology
  • Ocular Motility Disorders / surgery*
  • Oculomotor Muscles / physiopathology
  • Oculomotor Muscles / surgery*
  • Ophthalmologic Surgical Procedures*
  • Prospective Studies
  • Retrospective Studies
  • Strabismus / physiopathology
  • Strabismus / surgery*
  • Syndrome
  • Treatment Outcome
  • Vision, Binocular / physiology