Prevention and treatment of primary inferior obliqe muscle overaction

    Abstract

    Prevention and treatment of primary inferior obliqe muscle overaction

    V.B. Pushchina, I.L. Plisov, N.G. Antsiferova

    The S. Fyodorov Eye Microsurgery Federal State Institution, Ministry of Health of the Russian Federation, Novosibirsk Branch, Novosibirsk

    Purpose. To carry out retrospective analysis of frequency of primary hyperfunction (PH) of the inferior oblique muscle in patients with infantile esotropia; to assess influence of esodeviation reduction by a surgical, chemodenervational or prismatic method on the existing PH dynamics; to assess clinical and functional results of treatment.

    Materials and methods. The retrospective analysis of 572 patients’ cases lay in assessment of PH frequency and rate in patients with infantile esotropia appeared under 9 months with different treatment tactics. The prospective part of the research included two groups of patients. Group 1 (106 patients; 212 eyes) – studying the influence of surgical treatment of PH. Group 2 (127 patients; 207 eyes) – studying the effectiveness of surgical treatment.

    Conclusion. PH frequency in case of different treatment tactics for patients with infantile esotropia is from 17 to 69%, and the degree of its clinical manifestation is from 1.2±0.4 to 2.6±0.8. Bilateral weakening of medial rectus muscle reduces its probability up to 17-19%, and the degree of its manifestation up to 1.2±0.4. In cases of combination of PH with infantile esotropia from 20 to 25° with paretic component, it is reasonable to carry out esodeviation reduction by means of bilateral recession, chemorecession or prismatic correction as the first treatment stage, whereas the rate of existing PH is credibly reduced. In cases of choice of tactics, which is necessary for clinically significant reduction or elimination of PH, it is reasonable to carry out chemorecession, marginal partial myotomy or myectomy depending on the PIOOA manifestation.

    Key words: primary hyperfunction of the inferior oblique muscle, chemodenervation, prismatic correction, surgical treatment.