|Year : 1982 | Volume
| Issue : 4 | Page : 279-280
Anteropositioning of the inferior oblique muscle
VK Raju, IV Rao
Dept. of Ophthalmology, WVU Medical Center, Morgantown, WV 26506 +St. Peter's Hospilal, Chertsey, Surrey, England, United Kingdom
V K Raju
Dept. of Ophthalmology, WVU Medical Center, Morgantown, WV 26506, England
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Raju V K, Rao I V. Anteropositioning of the inferior oblique muscle. Indian J Ophthalmol 1982;30:279-80
A considerable division exists regarding the most effective technique for weakening the overacting inferior oblique muscle. The literature abounds with references either advocating or discouraging the three most comnonly accepted surgical techniques, inferior oblique myectomy, recession, and disinsertion, Duane, as quoted by White, popularized myotomy of the inferior oblique muscle at its origin. Recession of this muscle became an accepted alternative surgical technique during the 1950's. The disinsertion technique has been thoroughly described by White and Brown. Costenbader and Kertesz compared all these techniques and concluded that disinsertion is less complicated than the other methods and nearly as effective in eliminating overaction of the inferior oblique muscle. Parks held that recession is the most effective procedure; and myectomy between its origin and inferior rectus is the least effective. Parks also stated that the greater the degree of inferior obligue muscle overaction the less effective are any of these weakening procedures.
Still another surgical procedure exists for weakening the overacting inferior oblique muscle that has received little attention, according to the literature. This technique, known as anteropositioning of the inferior oblique muscle, was described by Gobin in 1964. The authors applied this technique and found it to be both simple and effective. Anteropositioning of this muscle means a displacement of the bulbar insertion of the muscle towards the equator of the eye. This enlarges the angle between the muscle and the optic axis, resulting in an extorsion and decreased vertical action. Gobin's description of this procedure is as follows: "--.in the lower temporal quadrant an incision is made through the conjunctiva and Tenon's capsule. The oblique muscle is picked up with a muscle hook and gripped at the tip of its insertion. Then a suture is placed at the equator of the globe just between the lateral and the inferior recti. After the suture has been placed the anterior part of the muscle insertion is cut along the sclera and the posterior part perpendicular to it, (i.e right across the muscle fibers). Thus the scissors do not follow the curvature of he eyeball, avoiding the posterior pole with its blood vessels. It is very important that no connections should remain between the inferior oblique and the sclera, otherwise elevation in adduction will persist. Finally, the suture, which is already attached to the sclera, is put through the anterior tip of the muscle and :tied. The posterior part of the muscle is left free. -It adjusts itself against the globe and is kept in its place by Tenon's capsule.
| Materials and methods|| |
Forty-eight cases of inferior oblique overaction (unilateral or bilateral) are included in this study. In 25 cases anteropositioning of the inferior oblique muscle is performed in the remaining 23 cases underwent the recession procedure. The postoperative follow-up period ranged from one year to two and one-half years. Thirty-seven of these cases, or 78%, also had surgery for esotropia along with the inferior oblique weakening procedure.
| Observations|| |
Although there existed varying degrees o. overaction preoperatively, both surgical techni . ques (i. e. anteropositioning of the inferior oblique muscle and recession) were equally effective in eliminating the overaction of this muscle. However the former technique was much simpler to perform.
Twenty of the cases, or 80% involving the anteropositioning technique had excellent results with no residual overaction of the inferior oblique muscles. Eighteen of the cases, or 78%, undergoing the recession technique also had excellent postoperative results.
| Summary|| |
Anteropositioning of the inferior oblique muscle is a simple and effective procedure in eliminating the overaction of this muscle. In the present study, anteropositioning was found to be just as effective as the recession technique, but much simpler to perform.
| References|| |
White, J. W., 1943, Arch. of Ophthal mol 29: 1033.
White, J. W. and Brown, H. W., 1939., Arch of Ophthalmol., 21:999
Costenbader, F. D., Kcrtesz E., 1964, Amer. J. Ophthalmol, 57, 276
Parks, M. N., 1972, Amer. •J. Ophthalmol 73: 107.
Gobin, M. H., 1964, Ophthalmologica (Basel) 148:325.