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Equatorial scleral anchor procedure reduces inferior oblique muscle overaction
The new procedure does not involve cutting the muscle, and it can be performed with a microincision.
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An equatorial scleral anchor procedure to reduce inferior oblique muscle overaction may offer additional advantages with similar efficacy compared with an anterior transposition technique, according to a study.
The procedure consists of suturing the muscle at the sclera in correspondence to the Gobin point using a non-absorbable 5-0 Gore-Tex suture with tendon sparing. It also can use a microincision to minimize the related tissue trauma and induce faster recovery, the study said.
“The benefits of the technique: The simplification of the procedure, the ability to modify it, the versatility and reversibility make it easily a good candidate for becoming the primary procedure,” corresponding author Lelio Sabetti, MD, told Ocular Surgery News.
Background
Eight patients with inferior oblique muscle overaction, ranging from 5 to 51 years old, were selected to undergo the new procedure.
The equatorial scleral anchor technique can be used in cases in which inferior oblique overaction is associated with elevation in adduction, superior oblique palsy, and V-pattern exotropia or esotropia, according to the study, which was published in Journal of Pediatric Ophthalmology and Strabismus.
The unilateral inferior oblique overaction induced an 18 ∆D vertical deviation in one patient. The elevation in adduction was related to essential infant esotropia in two patients, and five patients had V-pattern exotropia between 15 ∆D and 40 ∆D. Mean preoperative deviation was 27 ∆D, the study said.
The surgery was performed through a microincision in three cases.
Follow-up was performed 1 day and 4 months after surgery. The primary outcomes were reduction of lateral incomitance after surgery and the number of postoperative overcorrections or any kind of deviation opposite the original, the study said.
Results
At 4 months postoperatively, the two patients with essential infant esotropia had complete resolution of the elevation in adduction with no residual vertical imbalance, the study said. In the other two groups, the mean angle deviation was reduced to 8 ∆D exotropia in the group of five patients, and vertical deviation was reduced to 3 ∆D in the group with one patient.
All patients experienced improvement in lateral incomitance, the study said.
The obtained inferior oblique muscle weakening was due to the anchor at the Gobin point and reduction of the total muscle length, the study said. The procedure produces the same anatomical result of an 11-mm inferior oblique muscle resection, without having the muscle cut, the study said.
The cases that were performed with a microincision were “easier and faster,” the study said. The use of a microincision minimized related tissue trauma, induced a faster recovery and reduced the risks of postoperative adherence syndrome, the study said.
“The most beneficial aspect would be that the equatorial scleral anchor procedure … produces the same anatomical result,” Sabetti said. “But most importantly is that it is performed without cutting the muscle. It is performed with a microincision, which causes far less trauma to the tissue, and thus dramatically increases the recovery time for the patient.”
The learning curve for the procedure is similar to that for recession of the small oblique muscle procedure, but without detaching the tendon, Sabetti said.
There were no particular complications or precautions to anticipate.
“With regard to the future, it is important to continue trying to optimize the technical aspect of the surgery with regard to the statistical results and potential modifications of the procedure,” Sabetti said. – by Kristie L. Kahl
Reference:
Tomarchio S, et al. J Pediatr Ophthalmol Strabismus. 2015;doi:10.3928/01913913-20141230-09.For more information:
Lelio Sabetti, MD, can be reached at Via Eurialo 7, 00181, Rome, Italy; email: studiosabetti@yahoo.it.Disclosure: Sabetti reports no relevant financial disclosures.