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Graded anterior transposition of the inferior oblique muscle for V-pattern strabismus
Letters to the Editor GRADED ANTERIOR TRANSPOSITION OF THE INFERIOR OBLIQUE MUSCLE FOR V-PATTERN STRABISMUS
J AAPOS 2012;16:585. Copyright Ó 2012 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/$36.00
To the Editor: The purpose of the study by Akar and colleagues1 was to evaluate the efficacy of bilateral graded anterior transposition of the inferior oblique muscle for the correction of V-pattern strabismus associated with inferior oblique overaction. They are to be congratulated for collecting such a large series of patients. However, the authors did not take into account some important points. In their Methods section, the presence of V patterns was quantified by measuring the deviation at approximately 25 upgaze and approximately 35 downgaze. The amount of anterior transposition was determined by both the severity of the inferior oblique overaction and the extent of the V pattern. A satisfactory result was defined as V-pattern incomitance \10D. There is evidence that measuring the horizontal deviations in extreme up- and downgaze can increase the magnitude of the deviation patterns.2,3 Decisions and results based on approximate head positions in alphabet-pattern strabismus may be a bias in this study. Another point to take into account is the strength of the superior oblique muscle. It should be described before and after the surgery for each case. It is plausible that patients with a normal superior oblique might have a different outcome than patients with superior oblique underaction. We suggest the need for a prospective study, controlling the head position for strabismus measurements and the strength of the superior oblique muscles before and after surgery. We also believe it is important to compare surgical results with decisions based on extreme head position measurements to the ones based on the classical measurements at 25 .
GRADED ANTERIOR TRANSPOSITION OF THE INFERIOR OBLIQUE MUSCLE FOR V-PATTERN STRABISMUS
Leticia Procianoy, MD, PhD Hospital de Clınicas de Porto Alegre Porto Alegre, Rio Grande do Sul, Brazil Edson Procianoy, MD, PhD Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil References
To the Editor: Akar and colleagues1 have described a gradation of the modified Elliot and Nankin procedure for inferior oblique surgery. It would be interesting to know the outcome specifically in asymmetric cases. They mentioned that in such cases the inferior oblique muscle was reattached asymmetrically, but that fact should have been highlighted in their results. Were there any purely unilateral cases, and did their results diff er as the difference in asymmetry of inferior oblique overaction in both eyes varied? Furthermore, although the authors have nicely shown the effect of inferior oblique muscle surgery in correcting V-pattern strabismus, they do not clearly establish that the grading contributed to the success of the procedure. In this connection, it should be noted that Minguini and colleagues2 showed that anterior transposition was as effective as graded recession for primary inferior oblique muscle overaction, and Monteiro de Carvalho and colleagues3 suggested the addition of anterior transposition for larger V patterns. We thank the authors for publishing this series, which provides a platform for larger randomized studies of inferior oblique muscle surgery, especially those concerned with asymmetrical inferior oblique overaction. Jaspreet Sukhija, MD Advanced Eye Centre Post Graduate Institute of Medical Education and Research Chandigarh, India References 1. Akar S, G€ okyi git B, Yılmaz OF. Graded anterior transposition of the inferior oblique muscle for V-pattern strabismus. J AAPOS 2012;16: 286-90. 2. Minguini N, De Carvalho KM, De Ara ujo L, Crosta C. Anterior transposition compared to graded recession of the inferior oblique muscle for V-pattern strabismus. Strabismus 2004;12:221-5. 3. Monteiro de Carvalho KM, Minguini N, Dantas FJ, Lamas P, Jose NK. Quantification (grading) of inferior oblique muscle recession for V-pattern strabismus. Binocul Vis Strabismus Q 1998;13:181-4. Published online November 16, 2012.
1. Akar S, G€ okyi git B, Yilmaz OF. Graded anterior transposition of the inferior oblique muscle for V-pattern strabismus. J AAPOS 2012;16: 286-90. 2. Von Noorden GK, Olson CL. Diagnosis and surgical management of vertically incomitant horizontal strabismus. Am J Ophthal 1965;60: 434-42. 3. Procianoy E, Procianoy L. Prevalence of horizontal deviation pattern changes with measurements in extreme gazes. Eye 2008;22:229-32.
http://dx.doi.org/10.1016/j.jaapos.2012.09.003 J AAPOS 2012;16:585. Copyright Ó 2012 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/$36.00
Published online November 16, 2012.
To the Editor: We thank Drs Sukhija and Procianoy for their remarks, which we shall address in turn. With regard to
http://dx.doi.org/10.1016/j.jaapos.2012.09.001
Journal of AAPOS
REPLY
585
J AAPOS 2012;16:585. Copyright Ó 2012 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/$36.00
To the Editor: The purpose of the study by Akar and colleagues1 was to evaluate the efficacy of bilateral graded anterior transposition of the inferior oblique muscle for the correction of V-pattern strabismus associated with inferior oblique overaction. They are to be congratulated for collecting such a large series of patients. However, the authors did not take into account some important points. In their Methods section, the presence of V patterns was quantified by measuring the deviation at approximately 25 upgaze and approximately 35 downgaze. The amount of anterior transposition was determined by both the severity of the inferior oblique overaction and the extent of the V pattern. A satisfactory result was defined as V-pattern incomitance \10D. There is evidence that measuring the horizontal deviations in extreme up- and downgaze can increase the magnitude of the deviation patterns.2,3 Decisions and results based on approximate head positions in alphabet-pattern strabismus may be a bias in this study. Another point to take into account is the strength of the superior oblique muscle. It should be described before and after the surgery for each case. It is plausible that patients with a normal superior oblique might have a different outcome than patients with superior oblique underaction. We suggest the need for a prospective study, controlling the head position for strabismus measurements and the strength of the superior oblique muscles before and after surgery. We also believe it is important to compare surgical results with decisions based on extreme head position measurements to the ones based on the classical measurements at 25 .
GRADED ANTERIOR TRANSPOSITION OF THE INFERIOR OBLIQUE MUSCLE FOR V-PATTERN STRABISMUS
Leticia Procianoy, MD, PhD Hospital de Clınicas de Porto Alegre Porto Alegre, Rio Grande do Sul, Brazil Edson Procianoy, MD, PhD Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil References
To the Editor: Akar and colleagues1 have described a gradation of the modified Elliot and Nankin procedure for inferior oblique surgery. It would be interesting to know the outcome specifically in asymmetric cases. They mentioned that in such cases the inferior oblique muscle was reattached asymmetrically, but that fact should have been highlighted in their results. Were there any purely unilateral cases, and did their results diff er as the difference in asymmetry of inferior oblique overaction in both eyes varied? Furthermore, although the authors have nicely shown the effect of inferior oblique muscle surgery in correcting V-pattern strabismus, they do not clearly establish that the grading contributed to the success of the procedure. In this connection, it should be noted that Minguini and colleagues2 showed that anterior transposition was as effective as graded recession for primary inferior oblique muscle overaction, and Monteiro de Carvalho and colleagues3 suggested the addition of anterior transposition for larger V patterns. We thank the authors for publishing this series, which provides a platform for larger randomized studies of inferior oblique muscle surgery, especially those concerned with asymmetrical inferior oblique overaction. Jaspreet Sukhija, MD Advanced Eye Centre Post Graduate Institute of Medical Education and Research Chandigarh, India References 1. Akar S, G€ okyi git B, Yılmaz OF. Graded anterior transposition of the inferior oblique muscle for V-pattern strabismus. J AAPOS 2012;16: 286-90. 2. Minguini N, De Carvalho KM, De Ara ujo L, Crosta C. Anterior transposition compared to graded recession of the inferior oblique muscle for V-pattern strabismus. Strabismus 2004;12:221-5. 3. Monteiro de Carvalho KM, Minguini N, Dantas FJ, Lamas P, Jose NK. Quantification (grading) of inferior oblique muscle recession for V-pattern strabismus. Binocul Vis Strabismus Q 1998;13:181-4. Published online November 16, 2012.
1. Akar S, G€ okyi git B, Yilmaz OF. Graded anterior transposition of the inferior oblique muscle for V-pattern strabismus. J AAPOS 2012;16: 286-90. 2. Von Noorden GK, Olson CL. Diagnosis and surgical management of vertically incomitant horizontal strabismus. Am J Ophthal 1965;60: 434-42. 3. Procianoy E, Procianoy L. Prevalence of horizontal deviation pattern changes with measurements in extreme gazes. Eye 2008;22:229-32.
http://dx.doi.org/10.1016/j.jaapos.2012.09.003 J AAPOS 2012;16:585. Copyright Ó 2012 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/$36.00
Published online November 16, 2012.
To the Editor: We thank Drs Sukhija and Procianoy for their remarks, which we shall address in turn. With regard to
http://dx.doi.org/10.1016/j.jaapos.2012.09.001
Journal of AAPOS
REPLY
585