Abstract

P 024

Unilateral inferior oblique anterior transposition for correction of hypertropia in primary position

Vodičková K., Autrata R., Řehůřek J.
Department of Pediatric Ophthalmology, Faculty of Medicine, Masaryk University Hospital, Brno, Czech Republic

Objective: This study evaluates the long term outcomes of the surgical correction of manifest hypertropia in primary position with compensatory head turn by unilateral inferior oblique (IO) anterior transposition (IOAT).
Methods: We prospectively analysed the results of unilateral IOAT in 45 consecutive pediatric and adult patients with idiopathic hypertropia >10 PD in primary position and primary unilateral inferior oblique overaction (+3 or +4 on a scale from 0:no overaction to +4:maximum increase in adduction). All patients underwent unilateral IOAT surgery between 1995 and 2005. Fiveteen patients had esotropia and seven had exotropia 23 patients had hypertropia and IO overaction, without horizontal strabismus, and IOAT was the only procedure performed. In each case, the bunched IO muscle was anteriorly transposed to the lateral edge of the insertion of the inferior rectus muscle. Difference in preop. and postoperative measurements was evaluated by Wilcoxon rank sum test for two-samples nonindependent.
Results: Median age at the time of surgery was 13 years (range, 2 to 47 years.) Mean follow-up was 52 months (range, 12 to 136 months). Hypertropia in primary position decreased from a mean of 21.8 prism diopters (PD) (range, 12 to 36 PD) to 3.5 PD (range, 0 to 8 PD) (P<.01). Thirty-eight (84%) of the patients had an excellent postoperative result (residual hypertropia of 0 to 4 PD) and seven (16%) had a good result (5 to 8 PD). Inferior oblique overaction was eliminated in all patients. Nine patients developed a transient of 5 PD postoperative ipsilateral hypotropia in primary positron. Eleven patients (24%) presented limited elevation in adduction in the field of the operated IO.
Conclusions: Large idiopathic hypertropia associated with unilateral IO overaction can be effectively corrected by unilateral IOAT surgical technique. In some patients, limitation of elevation was occurred in forced upgaze, but this was of no cosmetic importance. This surgery reduces inferior oblique overaction but may cause an ipsilateral hypotropia.

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