[Treatment of large hypertropia following absence of inferior rectus by integrated anteriorization of inferior oblique combined with recession of superior rectus].

OBJECTIVE: To evaluate the effect of integrated anteriorization of inferior oblique muscle combined with recession of superior rectus to treat large hypertropia following absence of inferior rectus.

METHODS: It was a retrospective case series study. Integrated anteriorization of inferior oblique muscle means transposing inferior oblique muscle 8-10 mm posterior to the insertion directly to original insertion of inferior rectus without myotomy. We reviewed 5 patients with absence of inferior rectus muscle, who treated by integrated anteriorization of inferior oblique muscle combined with recession of superior rectus. The pre and post-operative vertical deviation in primary position, ocular motility, and abnormal head position were compared. The patients were followed up from 6 to 18 months, with average as 10.8 months.

RESULTS: Postoperatively, 4 patients showed orthophoria in primary position and 1 patient had 10 PD hypotropia. The infraduction deficits improved from -3.0 to -1.6. Meanwhile, there had been an average of -2.0 mild supraduction limitation. Abnormal head position (AHP) disappeared in 2 patients with AHP before operation. All the patients showed no change of cyclodeviation on fundus photograph. 5 patients were satisfied with the improvement of the appearance, and the follow-up results were stable, no other surgery again.

CONCLUSIONS: Integrated anteriorization of inferior oblique muscle combined with recession of superior rectus was an effective surgical selection to treat hypertropia with absence of inferior rectus muscle. This procedure doesn't need to cut off the inferior oblique muscle. The more convenient surgical procedure can reduce the risk of bleeding.