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Factors associated with changes in horizontal deviation after inferior oblique weakening surgery

Eye volume 38, pages 600–605 (2024)Cite this article

Subjects

Abstract

Background/aims

To identify the factors affecting postoperative horizontal deviation following isolated inferior oblique (IO) weakening surgery.

Methods

The medical records of patients who had undergone isolated IO weakening surgery between February 2010 and September 2021, with a minimum follow-up period of 6 months, were retrospectively reviewed. Patients were divided into two groups, eso-shift, and non-eso-shift, based on the change in horizontal deviation at postoperative 6 months. Eso-shift or exo-shift was defined as a change of 2Δ or more.

Results

A total of 77 patients were included. Among them, 49 patients (63.6%) showed changes in horizontal deviation: 37 (48.0%) eso-shift, 12 (15.6%) exo-shift. Twenty-eight patients (36.4%) showed no change in alignment. The eso-shift group showed the following characteristics compared to the non-eso-shift group: older age (P < 0.001), higher proportion of patients with preoperative exo-deviation (P < 0.001), and greater preoperative hypertropia in primary gaze (P < 0.001), down gaze (P = 0.031), ipsilateral gaze (P < 0.001), and ipsilateral head tilt (P = 0.002). Regarding the postoperative changes in horizontal deviation based on prior horizontal strabismus, patients with preoperative exo-deviation showed a statistically significant eso-shift. The patients with prior eso-deviation tended toward exo-shift, while those without prior horizontal deviation rarely changed.

Conclusion

Changes in postoperative horizontal deviation are associated with preoperative horizontal and vertical deviation, which might result from changes in the rectus muscle due to oblique muscle dysfunction. Also, this study suggests that isolated IO weakening surgery could effectively correct small-angle horizontal deviation in patients with inferior oblique overaction (IOOA) and horizontal strabismus.

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Fig. 1: Changes in postoperative horizontal deviation according to prior horizontal strabismus.

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Funding

This work is supported by grant No.0420200400 from the Seoul National University Hospital (SNUH) Research Fund.

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Authors and Affiliations

  1. Department of Ophthalmology, Ewha Womans University Seoul Hospital, Seoul, Korea

    Yujin Gim

  2. Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea

    Seong-Joon Kim

  3. Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

    Seong-Joon Kim

Authors
  1. Yujin Gim
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  2. Seong-Joon Kim
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Contributions

Conceptualization: S-JK. Study design: S-JK, YG. Data collection: YG. Data and statistical analyses: YG. Drafting the manuscript: YG. Critical revision and final approval of the article: S-JK.

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Correspondence to Seong-Joon Kim.

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Gim, Y., Kim, SJ. Factors associated with changes in horizontal deviation after inferior oblique weakening surgery. Eye 38, 600–605 (2024). https://doi.org/10.1038/s41433-023-02741-3

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