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Retro-equatorial inferior oblique myopexy for treatment of inferior oblique overaction

  • Neurophthalmology
  • Published:
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Abstract

Aim

To compare the effectiveness of inferior oblique retroequatorial myopexy and inferior oblique myectomy in correction of inferior oblique overaction (IOOA).

Patients and methods

This was a pilot study study including forty patients with primary IOOA of all grades, with or without primary position horizontal deviations. Patients were randomized to have either IO retroequatorial myopexy, group A, or IO myectomy, group B. Success was defined as elimination of the IOOA at 6 months postoperatively. Secondary outcome measures included residual or recurrent elevation in adduction, development of postoperative hypotropia in adduction, postoperative contralateral IOOA, major intraoperative complications, and reversibility of the procedure.

Results

At 6 months postoperative, the success rate was higher in the myectomy group (76%) than in the myopexy group (58%); however, this difference was not statistically significant (P = 0.1). The incidence of residual IOOA in myopexy group was significantly higher in patients with higher preoperative grades of IOOA (P ˂ 0.001). While this difference was not statistically significant among patients in myectomy group (P = 0.09). Collapse of V-pattern was acheived in nine (69%) patients in myopexy group compared with 8 (57%) in myectomy group with a statistically significant difference (P ≤ 0.001). No patients in myopexy group developed postoperative hypotropia in adduction or postoperative contralateral IOOA, compared with eight (22%) patients of myectomy group (P = 0.002) who developed postoperative hypotropia and two (66.6%) patients with unilateral IOOA who developed contralateral IOOA in myectomy group (P ˂ 0.001). No intraoperative complications were encountered in either group. postoperative.

Conclusions

Retroequatorial myopexy of the inferior oblique is as effective as inferior oblique myectomy in eliminating lower and moderate grades of primary IOOA; however, it is more effective in collapsing V-pattern associated with IOOA, and is not associated with postoperative hypotropia or contralateral IOOA after unilateral surgery. It can be used as a safe, reversible alternative to myectomy; however, it is not suitable for high grades of IOOA.

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Fig. 1

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Abbreviations

IOOA:

Inferior oblique overaction

IOAT:

Inferior oblique anterior transposition

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Author information

Authors and Affiliations

  1. Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Manal Kasem, Ibrahim T. El-adawy & Ameera G. Abdelhameed

  2. Memorial Institute of Ophthalmic Research, Giza, Egypt

    Heba Metwally

  3. Department of Ophthalmology, Ophthalmology Center, Faculty of Medicine, Mansoura University, Mansoura, 0201120090000, Egypt

    Ameera G. Abdelhameed

Authors
  1. Manal Kasem
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  2. Heba Metwally
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  3. Ibrahim T. El-adawy
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  4. Ameera G. Abdelhameed
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Contributions

The study idea and design was conceived by Heba Metwally. Literature screening and selection were performed by Ameera Abdelhameed. Patients selection and follow-up were performed by Heba metwally, Manal Kasem, and Ameera Abdelhameed. Data extraction and statistical synthesis were performed by Manal Kasem. Preparation of the first draft of the manuscript was done by Ameera Gamal and reviewed by Heba Metwally and Manal Kasem. Final review of the manuscript was performed by Heba metwally and Manal Kasem. All authors approved the final version of the manuscript that was submitted for publication.

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Correspondence to Ameera G. Abdelhameed.

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The authors declare that they have no conflict of interest

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All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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The manuscript was accepted in part as an oral presentation at 5th Magrabi International congress Abu-Dhabi 26th–28th January 2017.

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Kasem, M., Metwally, H., El-adawy, I.T. et al. Retro-equatorial inferior oblique myopexy for treatment of inferior oblique overaction. Graefes Arch Clin Exp Ophthalmol 258, 1991–1997 (2020). https://doi.org/10.1007/s00417-020-04742-4

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  • DOI: https://doi.org/10.1007/s00417-020-04742-4

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