Surgical management of long-standing antielevation syndrome after unilateral anterior transposition of the inferior oblique muscle.

Abstract

PURPOSE: To investigate surgical management of patients with long-standing antielevation syndrome following unilateral anterior transposition of inferior oblique muscle. METHODS: We present a series of 3 consecutive patients with significant hypotropia several years after unilateral anterior transposition surgery. An approach combining denervation-extirpation of the inferior oblique muscle and subsequent inferior rectus muscle recession and contralateral superior rectus muscle recession was used to manage all 3 patients. RESULTS: Denervation-extirpation surgery alone or with ipsilateral inferior rectus muscle recession were not enough to improve vertical misalignment in these patients. All 3 patients achieved successful results after denervation-extirpation surgery, ipsilateral inferior rectus muscle recession, and contralateral superior rectus muscle recession. CONCLUSIONS: In this case series, devervation-extirpation surgery on the inferior oblique muscle, ipsilateral inferior rectus recession, and contralateral superior rectus recession improved vertical misalignment in patients with long-standing antielevation syndrome after unilateral anterior transposition of the inferior oblique.