Different types of Inferior Oblique Surgery - The Private Eye Clinic
Different types of Inferior Oblique Surgery - The Private Eye Clinic
Different types of Inferior Oblique Surgery - The Private Eye Clinic
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12/14/2007Carlos Souza- DiasUnilateral IOAT• 10 pts with idiopathic unilateral IOOA;HT> than 10pd in PP; IOOA >/= +3• Results no hypo in PP4 pts – overcorrection without diplopia9/10 – residual HT < 6 pd; one- 8pdMean correction – 20pd for PP HTSantiago, IsenbergIOAT effect on torsion• 24 eyes <strong>of</strong> 13 pts• Fundus photos 1 week before and 6 w after thesurgery• Results 6 w postop -29% reduction <strong>of</strong> torsion10 w postop – 13% reduction <strong>of</strong> original torsion33% reduction if IOAT near or anterior to IR insertion8% reduction if IOAT posterior to IR insertionResidual fundus extorsion – recurrent IOOAStagerAnterior and nasal IOTStagerAnterior and nasal IOT• 20 pts with severe IOOA ( +4; absent SO; failed IOweakening)10 pts – unilateral ANT10pts- bilateral ANT9 pts – a secondary procedureResults : 10 pts with SOP5 pts cong SOP 5 pts acquired( post RD,Harada-Ito, tumor)FIG 1. A, Schematic representation (inferior view) <strong>of</strong> thetraditional anterior transposition <strong>of</strong> the IO muscle. B, Placingthe new IO muscleinsertion close to the temporal border <strong>of</strong> the IR muscledecreases the risk <strong>of</strong> AES.9 C, Placing the new insertion evenfurther nasally shoulddecrease the risk <strong>of</strong> AES even more.13 <strong>The</strong> axes x, y, and zare the axes <strong>of</strong> Fick and correspond to the directions <strong>of</strong>rotation <strong>of</strong> the globe.4 pts only ANT 1 after IOweak 1 with absent SOAll had improvement2 pts limitation <strong>of</strong> elevationStagerAnterior and nasal IOT4 pts with primary IOOA(3 had previous IO recess) improvedextorsion and IO function. All showed limitation <strong>of</strong> elevation2 pts with AES after IOAT – improvement2 pts with Duane: 1 eliminated increase in adduction1 no effect ( abnormal LR pulleys)1 pt with Y pattern – no effect ( abnormal IRResults <strong>of</strong> ANT decrease in elevation in adductiondecreased extorsiontonic depressionimprovement <strong>of</strong> head posture in severe SOPimprovement <strong>of</strong> V-patternStagerAnterior and nasal IOT• Limitations <strong>of</strong> ANTlimits elevationmay induce intorsioncould make downshoot worse in Duanemay not be successful after multiple surgeriesRecommended for severe or recurrent IOOA when othertechniques have failed4
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