| Purpose:To evaluate the efficacy of IOBT treating vertical deviation with mild to moderate IOOA.Methods:The medical records of patients,who underwent IOBT for VD and coexisting IOOA at the Second Hospital of Jilin University between april 2020 and august 2022,were retrospectively reviewed.All patients underwent general ophthalmological examination and strabismus specialist examination.Data were collected: age,gender,diagnosis,angle of deviation at distance and near(in the primary),ocular motility,FDA,V pattern,near stereopsis,compensatory head position.Criteria for successful surgery: 0 PD of primary position VD,without residual IOOA,10 PD or less of V pattern.Secondary outcome measures : motor success was defined as alignment within 10 PD at distance,stereoacuity 800" postoperatively and lack of stereopsis preoperatively were used to determine stereoscopic recovery,improvement or resolution of compensatory head position.Results:1.A total of 40 patients(45 eyes)were included in this study,14 males and 26 females with a mean age of 9.72±5.24 years(range,3–24 years).The follow-up period ranged from 1 to 27 months(mean,6months).Diagnoses were: IOOA coexist with exotropia(34 case),IOOA coexist with esotropia(6 cases),IOOA1+(22 case),IOOA2+(18 case),IOOA coexist with V pattern(19 case).2.(1)Correlation analysis of preoperative IOOA and VD: the preoperative IOOA was positively correlated with VD(distance and near),and the correlation coefficients were r = 0.439,0.431(P < 0.01).(2)The primary position VD at distance decreased to 4.37±2.99 PD,at near decreased to 4.35±2.38 PD,with an 85% success rate.The correction VD angle of IOOA1+ group was 3.45±2.84 PD,while IOOA2+ group was 5.50±2.85 PD,with86.36%、83.30% success rate.There was no statistical significance(P>0.05).The correction VD angle of V pattern group was 4.00 ± 3.32 PD,while non-V pattern group was 4.71 ± 2.70 PD,with 90.48% 、 78.95% success rate.There was no statistical significance(P>0.05).(3)The IOOA was 1.0(1.0,2.0)preoperatively and 0.0(0.0,0.0)postoperatively,the success rate of IOOA correction was 82.5%.IOOA1 + group and IOOA2 + group corrective success rates were 95.45% and 66.66% respectively.The difference was statistically significant(P<0.05).IOBT achieved better postoperative effect in individuals with 1+IOOA than 2+IOOA.V pattern group and non-V pattern group corrective success rates were 84.21% and 80.95%.There was no statistical significance(P>0.05).(4)The amount of V pattern was 20(17,26)PD preoperatively and 4(2,6)PD postoperatively,the success rate of V pattern correction was 89.47%.(5)The FDA showed a change of 4.68±5.05°.Patients had extorsion before surgery,which was modified to be almost normal after surgery,1 patients showed incyclotropia after surgery.The FDA change was 5.10 ±5.37 ° in the V pattern group and 4.62 ±4.79 ° in the non-V pattern group.The difference was not statistically significant(P>0.05).The FDA change was 4.06±4.44° in the IOOA1+ group and5.81±5.62° in the IOOA2+ group.The difference was not statistically significant(P>0.05).(6)Near stereopsis was restored in 10(41.6%)patients.Postoperative compensatory head position disappeared or improved in 11(84.61%)patients.(7)The primary position HD at distance of esotropia showed a diminution of42.5±17.17 PD,while the HD at near of exotropia was 50.33±18.51 PD,with an 83.3%success rate.The success rate was 91.17% for the HD at distance of exotropia correction,which showed a diminution of 38.23±19.28 PD,while the HD at near of exotropia was 43.11±21.85 PD.Conclusions1.IOBT might be a useful surgical treatment for patients with primary position hypertropia of less than 10 PD that was associated with mild to moderate IOOA,without any risk of Brown’s syndrome and anti-elevation syndrome.2.IOBT achieved better postoperative effect in individuals with 1+IOOA than2+IOOA.3.Unilateral IOBT achieved satisfactory outcomes in patients with V pattern that is associated with mild IOOA,without the risk of continuous A pattern. |
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