Comparison of Different Surgical Approaches to Inferior Oblique Overaction

The purpose of this study is to compare surgical outcomes of recession, anteriorization, and myotomy for the treatment of inferior oblique overaction (IOOA).

A retrospective chart review of all patients undergoing IOOA correction from July 2010 to March 2017 at the Children's Hospital of Colorado was performed. Preoperative grading of IOOA (+0.5 to +4.0) was compared to post-operative IOOA (0 to +4.0). The goal was reduction of IOOA to 0, but any decrease in IOOA was measured.

There were a total of 260 patients with 357 eyes. Gender and age were similar across surgery types. A 94.6% of eyes had a decrease in IOOA with recession (n = 165) of the inferior oblique while 86.1% decreased to no IOOA. Anteriorization of the inferior oblique (n = 115) decreased overaction in 97.4% of eyes with 81.7% improving to zero degree of IOOA. Myotomy of the inferior oblique (n = 77) was found to decrease overaction in 98.7% of eyes and reduce IOOA to zero in 88.3%. There was no significant difference among type of surgery and outcome.

All three surgical interventions were found to be equally successful in reducing the amount of IOOA.