Symmetric May Best Asymmetric Surgery for Hypertropia

Eric Butterman

October 25, 2011

October 25, 2011 (Orlando, Florida) — A 7-year study of inferior oblique surgery carried out at the University of Wisconsin, Madison, shows that primary gaze may be just as successful when treated through symmetric as through asymmetric inferior oblique surgery.

Timothy Daley, MD, a pediatric ophthalmology fellow at the University of Wisconsin, Madison, says the results, which he announced here at the American Academy of Ophthalmology (AAO) 2011 Annual Meeting, can be effectively used in surgical strategy and pressure.

"This can relieve anxiety when a surgeon would maybe ordinarily be stuck," Dr. Daley told Medscape Medical News. "With asymmetric [inferior oblique surgery], there can be trepidation on how much to recede, and now they can feel confident that if you do a 14 mm that you'll realize that you'll get a correction. It simplifies the thinking."

The study involved 39 patients with inferior oblique overaction, inferior oblique surgery recessions, or superior oblique palsy or paresis for V-pattern strabismus. Findings showed that symmetric inferior oblique surgery recessions were corrected in 93% of patients compared with 61% for asymmetric inferior oblique surgery (exclusions included vision worse than 20/60).

The researchers concluded that symmetric inferior oblique surgery may be superior in reducing overcorrection and improving attempts at vertical correction with regard to bilateral symmetric recession.

Says Herbert Kaufman, MD, professor emeritus of ophthalmology, pharmacology, and microbiology at Louisiana State University Medical School in Baton Rouge, commented on the symmetric findings: "It's definitely another way to correct the problem, and one that has to be thought of more."

Despite the results, Dr. Daley admits a weakness of the study is that the results came from just 1 surgeon, and they would like to add statistics of others into the mix. In addition, he says, only going up to 14 mm with symmetric surgeries leaves a question of how large the correction can go. "It would take faith to address those kinds of deviations," he said. In addition to his concerns, a final question could also be how the improvements in the procedure over the 7-year period would have affected the outcome.

American Academy of Ophthalmology (AAO) 2011 Annual Meeting: Abstract #180. Presented October 24, 2011.

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