Korean J Ophthalmol.  2006 Jun;20(2):118-123. 10.3341/kjo.2006.20.2.118.

Antielevation Syndrome after Unilateral Anteriorization of the Inferior Oblique Muscle

• Cho YA
• Kim JH
• Kim S

• KMID: 1099047
• DOI: http://doi.org/10.3341/kjo.2006.20.2.118

Abstract

PURPOSE: To report antielevation syndrome with restriction of elevation on abduction in the operated eye and overaction (OA) of the inferior oblique muscle (IO) of the contralateral eye after unilateral IO anteriorization (AT). METHODS: Medical records were reviewed retrospectively in 8 of 24 patients who underwent unilateral IOAT. Four patients were referred from other hospitals after the same surgery. RESULTS: Four patients had infantile esotropes. The rest showed accommodative esotropia, superior oblique palsy, exotropia, and consecutive exotropia. The mean amount of hyperdeviation was 16.3 PD (10~30). The mean restriction of elevation on abduction in the operated eye was -1.6 (-1~-4) and IOOA of the contralateral eye was +2.7 (+2~+3). IOAT of nonoperated eyes in 4 patients, IO weakening procedure of anteriorized eyes in 2 patients, and IO myectomy on an eye with IOAT in 1 patient were performed. Ocular motility was improved after surgery in all patients. CONCLUSIONS: Unilateral IOAT may result in antielevation syndrome. Therefore bilateral IOAT is recommended to balance antielevation in both eyes. A meticulous caution is needed when performing unilateral IOAT.

Keyword

Anteriorization of inferior oblique muscle; Antielevation syndrome; Limitation of elevation in abduction; Overaction of inferior oblique muscle

MeSH Terms

Syndrome
Retrospective Studies
Reoperation
Postoperative Complications
*Ophthalmologic Surgical Procedures
Oculomotor Muscles/physiopathology/*surgery
Ocular Motility Disorders/*etiology/physiopathology/surgery
Infant
Humans
Follow-Up Studies
Female
Eye Movements/*physiology
Exotropia/surgery
Esotropia/surgery
Child, Preschool
Child
Adult

Figure

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  Fig. 1-1 Seven months after unilateral anteriorization of the inferior oblique muscle (IO) in the left eye, patient No. 2 developed anti-elevation syndrome. The patient showed limitation of elevation on abduction in the left eye and overaction of the IO in the right eye.

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  Fig. 1-2 After anteriorization of the right inferior oblique muscle, overaction of the muscle disappeared. The patient showed orthophoria in the primary gaze and almost symmetrical versional movement in upgazes despite mild upward limitation of the left eye.

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  Fig. 2-1 Patient No. 5 was referred to our hospital after 10 mm recession of the right inferior oblique muscle (IO) and anteriorization of the left IO. He showed limitation of elevation of the left eye, especially in abduction, and overaction of the IO and superior rectus muscle in the right eye (antielevation syndrome). At surgery, the posterior half of the prerecessed IO of the right eye was intact and was only recessed 10 mm to equalize it with the anterior half of the IO fiber.

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  Fig. 2-2 After 10 mm myectomy of the posterior half of the inferior oblique muscle (IO) from the original insertion and 4.5 mm recession of the superior rectus muscle in the right eye, patient No. 5 obtained normal function of the IO. However, small DVD of the left eye appeared in upgaze without spontaneous elevation.

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