May 31, 2019 Conference
Dr. Maan Alkharashi, Boston Children's Hospital
Authors: Christina Scelfo, MD; Maan Alkharashi, MD
Introduction: We aim to evaluate the surgical success and need for adjustment due to overcorrection in patients who undergo inferior oblique myectomy (IOM) combined with lateral rectus recession (LRc) for exotropia in the setting of inferior oblique overaction.
Methods: We conducted a retrospective chart review of patients with exotropia who underwent LRc using adjustable sutures alone versus LRc combined with IOM from January 2010 to present at our institution. Binocular alignment was recorded before and within one week of surgery. We evaluated post-operative alignment, surgical success (distance alignment of ?10PD), and need for post-operative adjustment due to overcorrection.
Results: The chart review identified 48 patients. Twenty-four underwent LRc alone and 24 underwent LRc combined with IOM. Surgical success was significantly higher in the lateral rectus recession alone group (91.6%) compared to the IOM group (62.5%) (P=0.036). The need for post-operative adjustment due to overcorrection was also significantly higher in the IOM group (20.8%) compared to the LRc alone group (0%) (P=0.049).
Discussion: In this study, more patients needed adjustment for overcorrection when undergoing LRc combined with IOM compared with LRc alone. Since the tertiary action of the inferior oblique is abduction, it is possible that in patients with inferior oblique overaction, weakening the inferior oblique surgically causes more esodeviation and overcorrection.
Conclusion: Surgical correction of exotropia and inferior oblique overaction with LRc combined with IOM may lead to overcorrection and increased need for post-operative adjustment.