Abstract
Purpose
To report the causes of persistent inferior oblique (IO) overactions after disinsertion procedure.
Methods
Surgical findings of nine eyes of eight patients who needed secondary surgery to the IO muscles because of persistent overaction after IO disinsertion were evaluated retrospectively. Inferior obliques were found partially retracted into their sheath, and some parts of the proximal muscle stumps were found to have established attachments through scar tissues to the sclera in five eyes. They were totally in the subtenon space, reattached to the sclera in the three eyes and were found untouched; inferior rectus was disinserted instead of IO muscle, in the last eye. Proximal terminals of the IOs were isolated, dissected from its sheath and from other fascial attachments. The muscle stump pushed out of subtenon’s space through its Tenon’s sheath after 5–8 mm myectomy and cauterization to prevent any direct or indirect contact between the muscle and sclera.
Results
Persistent overactions of IO muscles were resolved in all cases and did not return in any case in the follow-up period of 4 months to 6 years.
Conclusions
Persistent overaction of IO muscle after disinsertion usually results from insufficient retraction of the muscle from the subtenon’s space. It can be both prevented and managed by complete dissection of the IO muscle from its all fascial attachments and pushing the proximal terminal of the muscle completely out of subtenon’s space through its sheath traversing Tenon’s capsule after a segment myectomy and cauterization.
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References
Davis G, McNeer KW, Spencer RF (1986) Myectomy of the inferior oblique muscle. Arch Opthalmol 104:855–858
Parks MM (1972) The weakening surgical procedures for eliminating overaction of the inferior oblique muscle. Am J Opthalmol 73:107–122
Parks MM (1974) The overacting inferior oblique muscle. The XXXVI DeSchweinitz lecture. Am J Opthalmol 77:787–797
Oh SY, Poukens V, Demer JL (2001) Quantitative analysis of rectus extraocular muscle layers in monkey and humans. Invest Ophthalmol Vis Sci 42:10–16
Demer JL (2004) Pivotal role of orbital connective tissues in binocular alignment and strabismus. Invest Ophthalmol Vis Sci 45:729–738
Fink WH (1955) The role of developmental anomalies in vertical muscle defects. Am J Opthalmol 40:529–553
Dunlap EA (1972) Inferior oblique weakening. Ann Ophthalmol 4:905–912
Helveston EM, Haldi BA (1976) Surgical weakening of the inferior oblique. Int Ophthalmol Clin 16(3):113–126
Del Monte MA, Parks MM (1983) Denervation and extirpation of the inferior oblique; an improved weakening procedure for marked overaction. Opthalmology 90:1178–1184
Mims JL, Wood RC (1989) Bilateral anterior transposition of the inferior obliques. Opthalmology 107:41–44
Squirrell David M, Sears Katharine S, Burke John P (2007) Reexploration and inferior oblique myectomy temporal to the inferior rectus to treat persistent inferior oblique overaction. J AAPOS 11(1):48–51
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For this type of study, hospital-based and retrospective, formal consent is not required.
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Koc, F. Surgical exploration in persistent inferior oblique overactions. Int Ophthalmol 37, 1319–1322 (2017). https://doi.org/10.1007/s10792-016-0416-z
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DOI: https://doi.org/10.1007/s10792-016-0416-z