Skip to main content
SpringerLink
Log in

Asymmetric inferior oblique anterior transposition for incomitant asymmetric dissociated vertical deviation

  • Pediatrics
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

Inferior oblique anterior transposition (IOAT) is indicated in patients with incomitant dissociated vertical deviation (DVD) larger in adduction. In general, bilateral surgery is recommended in patients with DVD unless there is deep monocular amblyopia. The purpose of this study is to evaluate the results of asymmetric IOAT in patients with asymmetric incomitant DVD larger in adduction.

Methods

Retrospective chart review of the records of all patients with incomitant asymmetric DVD associated with inferior oblique (IO) overaction who underwent asymmetric IO weakening procedure. In all patients, the eye with more DVD in adduction underwent IOAT to the temporal corner of the insertion of the inferior rectus (IR) muscle, and the eye with less DVD underwent IOAT to a position 3–4 mm posterior to the insertion of the IR. No other muscles were operated simultaneously. No patient had previous surgery on any cyclovertical extracular muscle.

Results

Fourteen patients were included. Mean age at surgery was 10.3 ± 8.8 years (range 4–33). Primary position DVD preoperatively was 18 ± 2 PD in the eye with the larger DVD compared to 1.1 ± 1.0 PD postoperatively (p < 0.0001). DVD asymmetry between the lateral gaze with the largest DVD and the lateral gaze with the smallest DVD was 9.8 ± 3.1 PD (range 5–14 PD) preoperatively vs 1.1 ± 1.0 PD (range 0–2 PD), (p < 0.0001). Ten patients had preoperative V-pattern >10 PD (24.7 ± 8.7 PD, range 12–50 PD) preoperatively vs no patients postoperatively (mean V-pattern 4.4 ± 2.0 PD), (p < 0.0001). Postoperative follow up was 1.6 ± 0.7 years (range 1–3 years).

Conclusion

In patients with asymmetric incomitant DVD, asymmetric IOAT improves lateral incomitance without increasing the risk of antielevation, limitation in upgaze rotation, or hypertropia, or worsening the DVD in the eye with less deviation preoperatively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Magoon E, Cruciger M, Jampolsky A (1982) Dissociated vertical deviation: an asymmetric condition treated with large bilateral superior rectus recession. J Pediatr Ophthalmol Strabismus 19:152–156

    PubMed  CAS  Google Scholar 

  2. Schwartz T, Scott W (1991) Unilateral superior rectus recession for the treatment of dissociated vertical deviation. J Pediatr Ophthalmol Strabismus 28:219–222

    PubMed  CAS  Google Scholar 

  3. Bacal DA, Nelson LB (1992) Anterior transposition of the inferior oblique muscle for both dissociated vertical deviation and/or inferior oblique overaction. Binocular Vision Eye Muscle Q 7:219–225

    Google Scholar 

  4. Kratz RE, Rogers GL, Bremer DL, Leguire LE (1989) Anterior tendon displacement of the inferior oblique for DVD. J Pediatr Ophthalmol Strabismus 26:212–217

    PubMed  CAS  Google Scholar 

  5. Mims JL 3rd, Wood RC (1989) Bilateral anterior transposition of the inferior obliques. Arch Ophthalmol 107:41–44

    Article  PubMed  Google Scholar 

  6. Santiago AP, Rosenbaum AL (1999) Dissociated vertical deviation. In: Santiago AP, Rosenbaum AL (eds) Clinical strabismus management. W.B. Saunders, Philadelphia, pp 237–248

    Google Scholar 

  7. Bremer DL, Rogers GL, Quick LD (1986) Primary-position hypotropia after anterior transposition of the inferior oblique. Arch Ophthalmol 104:229–232

    Article  PubMed  CAS  Google Scholar 

  8. Stager DR, Weakley DR Jr, Stager D (1992) Anterior transposition of the inferior oblique. Anatomic assessment of the neurovascular bundle. Arch Ophthalmol 110:360–362

    Article  PubMed  CAS  Google Scholar 

  9. Stidham DB, Stager DR, Kamm KE, Grange RW (1997) Stiffness of the inferior oblique neurofibrovascular bundle. Invest Ophthalmol Vis Sci 38:1314–1320

    PubMed  CAS  Google Scholar 

  10. Isenberg SJ, Apt L (1999) Inferior oblique weakening procedures: technique and indications. In: Santiago AP, Rosenbaum AL (eds) Clinical strabismus management. W.B. Saunders, Philadelphia, pp 449–458

    Google Scholar 

  11. Gobin MH (1969) Cyclotropia and Squint. Knol & Coutin, Antwerp

    Google Scholar 

  12. Black BC (1997) Results of anterior transposition of the inferior oblique muscle in incomitant dissociated vertical deviation. J AAPOS 1:83–87

    Article  PubMed  CAS  Google Scholar 

  13. Burke JP, Scott WE, Kutshke PJ (1993) Anterior transposition of the inferior oblique muscle for dissociated vertical deviation. Ophthalmology 100:245–250

    PubMed  CAS  Google Scholar 

  14. Fard MA (2010) Anterior and nasal transposition of the inferior oblique muscle for dissociated vertical deviation associated with inferior oblique muscle overaction. J AAPOS 14:35–38. doi:10.1016/j.jaapos.2009.11.011

    Article  PubMed  Google Scholar 

  15. Guemes A, Wright KW (1998) Effect of graded anterior transposition of the inferior oblique muscle on versions and vertical deviation in primary position. J AAPOS 2:201–206

    Article  PubMed  CAS  Google Scholar 

  16. Velez FG, Ela-Dalman N, Velez G (2009) Surgical management of dissociated vertical deviation associated with A-pattern strabismus. J AAPOS 13:31–35

    Article  PubMed  Google Scholar 

  17. Velez G (2001) A clinical classification of dissociated vertical deviation for better surgical approach. In: Smith Kettlewell Eye Research Institute Festschrift for Arthur Jampolsky. The Smith Kettlewell Eye Research Institute, San Francisco, pp 59–63

    Google Scholar 

Download references

Acknowledgments

Grant support

NIH/NEI K23EY021762 (SLP), Knights Templar Eye Foundation, Oppenheimer Family Foundation

Conflicts of interest

None of the authors have any financial conflicts of interest.

Author information

Authors and Affiliations

  1. Jules Stein Eye Institute and Department of Ophthalmology, University of California, Los Angeles, CA, U.S.A.

    Stacy L. Pineles & Federico G. Velez

  2. University of Antiquia, Private Practice, Medellin, Colombia

    Guillermo Velez

  3. Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, 100 Stein Plaza, Los Angles, CA, 90095-7002, USA

    Federico G. Velez

Authors
  1. Stacy L. Pineles
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guillermo Velez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federico G. Velez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Federico G. Velez.

Additional information

The authors have had full control of all primary data, and we agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review our data upon request.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pineles, S.L., Velez, G. & Velez, F.G. Asymmetric inferior oblique anterior transposition for incomitant asymmetric dissociated vertical deviation. Graefes Arch Clin Exp Ophthalmol 251, 2639–2642 (2013). https://doi.org/10.1007/s00417-013-2445-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-013-2445-x

Keywords

Search

Navigation