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 of 13 pts• Fundus photos 1 week before and 6 w after thesurgery• Results 6 w postop -29% reduction of torsion10 w postop – 13% reduction of 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) of thetraditional anterior transposition of the IO muscle. B, Placingthe new IO muscleinsertion close to the temporal border of the IR muscledecreases the risk of AES.9 C, Placing the new insertion evenfurther nasally shoulddecrease the risk of AES even more.13 The axes x, y, and zare the axes of Fick and correspond to the directions ofrotation of the globe.4 pts only ANT 1 after IOweak 1 with absent SOAll had improvement2 pts limitation of elevationStagerAnterior and nasal IOT4 pts with primary IOOA(3 had previous IO recess) improvedextorsion and IO function. All showed limitation of 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 of ANT decrease in elevation in adductiondecreased extorsiontonic depressionimprovement of head posture in severe SOPimprovement of V-patternStagerAnterior and nasal IOT• Limitations of ANTlimits elevationmay induce intorsioncould make downshoot worse in Duanemay not be successful after multiple surgeriesRecommended for severe or recurrent IOOA when othertechniques have failed4
12/14/2007StagerANT in pts with missing SO tendon• 9 pts were included2- unilateral7- bilateralResultsunilateral-Ortho in all gazes-1 - 5* tilt-1 – mild overcorrectionbilateral-6 – no IOOA-1 – no effect in both eyes-1 – overcorrection-2eyes– SO underactionappeared worse-22 pts had additionaloperationsOther surgical procedures• Gonzales, Klein 4mm distal myectomy + IOAT forprimary IOOA and IOOA+DVD :86% - n IO function85%- improvement of DVD• Stager, Weakly 5mm proximal (nasal) myectomy+IOAT of the distal part for recurrent IOOA, DVD:IOOA was eliminated in all casesDVD reduced in 4/17; unchanged10/17; increased in 3/17How should we proceed?5
Page 1 and 2: 12/14/2007• Duane - tenotomy/myec

Different types of Inferior Oblique Surgery - The Private Eye Clinic

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