Comparison of Astigmatism Induced by Combined Inferior Oblique Anterior Transposition Procedure and Lateral Rectus Recession Alone
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Purpose: The purpose of this study is to compare the magnitude and axis of astigmatism induced by a combinedinferior oblique (IO) anterior transposition procedure with lateral rectus (LR) recession versus LR recession alone. Methods: Forty-six patients were retrospectively analyzed. The subjects were divided into two groups: thosehaving concurrent inferior oblique muscle overaction (IOOA) and intermittent exotropia (group 1, 20 patients)and those having only intermittent exotropia as a control (group 2, 26 patients). Group 1 underwent combinedanterior transposition of IO with LR recession and group 2 underwent LR recession alone. Induced astigmatismwas defined as the difference between preoperative and postoperative astigmatism using double-anglevector analysis. Cylinder power, axis of induced astigmatism, and spherical equivalent were analyzed at 1week, 1 month, and 3 months after surgery. Results: Larger changes in the axis of induced astigmatism were observed in group 1, with 4.5° incyclotorsion,than in group 2 at 1 week after surgery (axis, 84.5° vs. 91°; p < 0.001). However, there was no statisticallysignificant inter-group difference thereafter. Relaxation and rapid regression in the incyclotorsion of inducedastigmatism were observed over-time. Spherical equivalent significantly decreased postoperatively at 1 monthin both groups, indicating a myopic shift (p = 0.011 for group 1 and p = 0.019 for group 2) but did not show significantdifferences at 3 months after surgery (p = 0.107 for group 1 and p = 0.760 for group 2). Conclusions: Combined IO anterior transposition procedures caused an increased change in the axis of inducedastigmatism, including temporary incyclotorsion, during the first week after surgery. However, this significantdifference was not maintained thereafter. Thus, combined IO surgery with LR recession does not seemto produce a sustained astigmatic change, which can be a potential risk factor of postoperative amblyopia ordiplopia compared with LR recession alone.
Abstract
Purpose: The purpose of this study is to compare the magnitude and axis of astigmatism induced by a combinedinferior oblique (IO) anterior transposition procedure with lateral rectus (LR) recession versus LR recession alone. Methods: Forty-six patients were retrospectively analyzed. The subjects were divided into two groups: thosehaving concurrent inferior oblique muscle overaction (IOOA) and intermittent exotropia (group 1, 20 patients)and those having only intermittent exotropia as a control (group 2, 26 patients). Group 1 underwent combinedanterior transposition of IO with LR recession and group 2 underwent LR recession alone. Induced astigmatismwas defined as the difference between preoperative and postoperative astigmatism using double-anglevector analysis. Cylinder power, axis of induced astigmatism, and spherical equivalent were analyzed at 1week, 1 month, and 3 months after surgery. Results: Larger changes in the axis of induced astigmatism were observed in group 1, with 4.5° incyclotorsion,than in group 2 at 1 week after surgery (axis, 84.5° vs. 91°; p < 0.001). However, there was no statisticallysignificant inter-group difference thereafter. Relaxation and rapid regression in the incyclotorsion of inducedastigmatism were observed over-time. Spherical equivalent significantly decreased postoperatively at 1 monthin both groups, indicating a myopic shift (p = 0.011 for group 1 and p = 0.019 for group 2) but did not show significantdifferences at 3 months after surgery (p = 0.107 for group 1 and p = 0.760 for group 2). Conclusions: Combined IO anterior transposition procedures caused an increased change in the axis of inducedastigmatism, including temporary incyclotorsion, during the first week after surgery. However, this significantdifference was not maintained thereafter. Thus, combined IO surgery with LR recession does not seemto produce a sustained astigmatic change, which can be a potential risk factor of postoperative amblyopia ordiplopia compared with LR recession alone.
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