Fat adherence syndrome following inferior oblique surgery: Treatment and outcomes

Describe surgical treatment and results in a group of patients diagnosed and operated on of fat adherence syndrome following inferior oblique surgery.

Retrospective study of 6 cases diagnosed and treated of fat adherence syndrome following inferior oblique surgery. Mean age was 24.67 years (range, 5-41), 3 males, 5 unilateral and 1 bilateral. Mean vertical deviation was 16.16pd (range, 4-25). Esotropia was associated in 4 cases, diplopia in other 2, and anomalous head posture in 3. A good outcome was considered when the final deviation was less than 10pd, with mild limitation of elevation, without anomalous head posture, and a negative duction forced test.

The final vertical deviation was 6.83pd (range, 0-14). A 2-4mm inferior rectus recession was performed on 4 patients associated to an inferior oblique surgery/exploration. All patients were operated on once, except 1 case. A good outcome was achieved in 3 patients. Anomalous head posture was resolved in 2 of 3 cases. Diplopia resolved after surgery. Only one case achieved orthophoria. Mean evolution time was 34.83 months (range, 6-78).

In the treatment of the fat adherence syndrome, an inferior rectus recession is recommended, associated to inferior oblique exploration or surgery. A good favorable outcome was only achieved in half of the cases with surgical treatment. Limitation of elevation could not be completely resolved in any of the patients.