Session: Free papers Session VIII - Graves & Neurologic disease

Contralateral recession of the inferior oblique muscle in Grave’s disease patients with Inferior rectus fibrosis with and without prior Inferior rectus recessions

Contralateral recession of the inferior oblique muscle in Grave’s disease patients with Inferior rectus fibrosis with and without prior Inferior rectus recessions



Introduction: The aim of the study was to evaluate the dose effect on vertical deviation and cyclotorsion and to assess the resulting binocular single vision after inferior oblique recession in patients with Grave’s orbitopathy.

Methods and patients: Patients without (group 1; n=52) and with prior inferior rectus recession (group 2, n=10) were evaluated. Inclusion criteria was a small vertical squint angle with excyclotorsion. The median preoperativ vertical squint angle was 4° [ 8 pdpt] in primary position and 7,3° in adduction [14 pdpt]. Preoperative Excyclotorsion was 5° [10 pdpt] in PP. The recession distance was preoperatively determined: 0,5° squint angle reduction in PP per mm recession distance [1]

Results: Inferior oblique recession generated a good field of binocular single vision (BSV) for both groups of patients (group 1 achieved 79 % BSV in PP and group 2 80 % BSV in PP). 60 % of the patients were completely diplopia free in downgaze. Squint angle reduction was in group 1 0,4 °/per mm recession distance and 0,54°/mm in group 2 in primary position. The vert. deviation side difference influenced the dose effect. Excyclotorsion was reduced to ≤2° in 40 % of the patients in group 1 and 50% in group 2. 

Conclusion: Inf. obl. muscle recession can be very successfully performed at the contralateral eye in patients with inferior rectus muscle fibrosis either as a primary prodecure or as a second step after maximal inferior rectus recession.  The major advantage of this procedure is that overdosage will cause diplopia in upgaze more than in downgaze, which is much less troublesome in daily routine. 

1.           Eckstein, A., et al., [Contralateral Recession of the Inferior Oblique Muscle in Grave's Disease Patients with Mild M. rectus inferior fibrosis]. Klin Monbl Augenheilkd, 2015. 232(10): p. 1178-83.