| Purposes:To evaluate the efficacy of anterior transposition of the inferior oblique muscle(IO) for the treatment of dissociated vertical deviation(DVD) with inferior oblique overaction(IOOA) and superior oblique palsy with secondary overaction of the IO;To evaluate the efficacy of bilateral equal IO anteriorization for asymmetric DVD with IOOA;To observe the incidence of antielevation syndrome (AES) after surgery.Methods:The medical records of consecutive 78 patients(103 eyes),who underwent anterior transposition of IO for vertical deviation with coexisting IOOA at Tianjin Eye Hospital between January 2003 and November 2007 and met the inclusion criteria,were retrospectively reviewed.Mean follow-up was 5.5 months (range,1 to 60 months).In the 56 cases(80 eyes) with DVD,the amount of vertical deviation in primary position were compared between pre- and postoperation at either 5m or 33cm distance respectively.The degree of inferior oblique overaction were compared between pre- and postoperation.The spearman coefficient of correlation was used to verify the correlation between the amount of vertical deviation in primary position preoperation and the degree of coexisting IOOA at either distance respectively.So were done in the 22 cases(23 eyes) with superior oblique palsy.In the 16 of 56 cases,who underwent bilateral equal IO anteriorization for asymmetric DVD with IOOA,the amount of the difference in vertical deviation in primary position of the asymmetric bilateral DVD were compared between pre- and postoperation at either distance respectively.It was also observed whether the changes of coexisting bilateral IOOA were symmetric or not after surgery.There were 23 cases whose postoperative periods were 6 months or more and follow-up was visited by the same person.It was observed that which eye performing IO procedure would develop AES in the 23 cases;The incidence of AES was compared between the cases performing unilateral and bilateral IO anteriorization in the 11 of 23 cases,who combined with DVD.Results:In the 56 cases(80 eyes) with DVD,the mean correction of vertical deviation in primary position at 5m was(13.56±6.57)prism diopters(PD) and (12.93±6.31)PD at 33cm,the 95%confidence interval(CI) was(12.12,15.00)PD and (11.55,14.31)PD respectively(Z=7.776,P＜0.01).Mean inferior oblique overaction decreased from +2 to 0(Z=7.771,P＜0.01).There was a positive correlation between the amount of vertical deviation in primary position preoperation and the degree of coexisting IOOA(5m:r_s=0.454,P＜0.01;33cm:r_s=0.554,P＜0.01).In the 22 cases (23 eyes) with superior oblique palsy,the mean correction of vertical deviation at 5m was(15.04±6.64)PD and(15.83±6.92)PD at 33cm(T=276.0,P＜0.01).Mean inferior oblique overaction decreased from +3 to 0(T=276.0,P＜0.01).There was a positive correlation between the amount of vertical deviation preoperation and the degree of secondary IOOA too(5m:r_s=0.494,P＜0.05;33cm:r_s=0.536,P＜0.01).The 16 cases with asymmetric DVD had a statistically significant reduction between preoperative difference and postoperative difference after bilateral equal procedure(5m:T=1.5, P＜0.01;33cm:T=120.0,P＜0.01);7 caess(43.75%) showed no asymmetric DVD in primary position at either distance,and eleven(68.75%) showed bilateral coexisting IOOA were both eleminated at the same time.After surgery,eight(34.78%) of the 23 cases showed no AES,whereas fifteen(65.22%) showed AES;In the 11 cases with DVD,there was no statistically significant difference in the incidence of AES between the the cases performing unilateral and bilateral IO anteriorization(P＞0.05).Conclusions:Anterior transposition of IO is an effective treatment for DVD combined with IOOA,the mean correction of vertical deviation in primary position at 5m was(13.56±6.57)PD and(12.93±6.31)PD at 33cm,and coexisting IOOA is eleminated.For the treatment of superior oblique palsy with secondary IOOA, although IO anteriorization can correct vertical deviation at either distance and eleminate secondary IOOA at the same time,the patients demonstrated residual hypertropia after surgery and the risk of later development of AES in the operated eye, it may be best to be cautious when considering only use of this procedure in these cases,especially in patients with larger vertical deviations.Bilateral equal IO anteriorization should be considered as an effective technique for asymmetric DVD with IOOA,and bilateral coexisting IOOA were both eleminated in most cases (68.75%).There was no statistically significant difference in the incidence of AES between the cases with DVD performing unilateral and bilateral IO anteriorization (P＞0.05). |
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