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. 2025 Apr 19;25(1):167.
doi: 10.1186/s12893-025-02882-0.

Assessment of combined transposition of the inferior oblique muscle belly without disinsertion and contralateral inferior oblique recession for treating asymmetric inferior oblique muscle overaction (IOOA)

Xiaolin Yin  1 , Lei Jin  2 , Qian Li  1 , Te Fu  1 , Longge Sun  3
Affiliations

Assessment of combined transposition of the inferior oblique muscle belly without disinsertion and contralateral inferior oblique recession for treating asymmetric inferior oblique muscle overaction (IOOA)

Xiaolin Yin et al. BMC Surg. .

Abstract

Background: This study aimed to investigate the efficacy of inferior oblique belly transposition (IOBT) combined with contralateral inferior oblique recession in treating bilateral asymmetric inferior oblique overaction (IOOA).

Methods: A retrospective study was conducted on 23 patients with asymmetric IOOA. IOBT was performed on the less affected eye of the patient, while the contralateral inferior oblique recession was conducted on the more affected eye. Pre- and post-operative changes in the vertical deviation, V-value, fovea-disc angle (FDA), and inferior oblique muscle function were compared. Follow-up duration ranged from 3 to 8 months.

Results: The V-pattern was corrected in all cases, and the V-value improved from 14.57 ± 4.50 preoperatively to 4.09 ± 2.17 postoperatively (t = 12.640, P < 0.001). The preoperative vertical deviation (5 m) significantly decreased from 8.04 ± 3.08 to 1.57 ± 1.90 postoperatively (t = 8.713, P < 0.001). Similarly, the lesser side FDA reduced from 11.39° ± 2.39° before surgery to 6.62° ± 1.11° after surgery (t = 11.132, P < 0.001). On the greater side, the FDA also showed significant improvement, reducing from 14.39° ± 2.45° preoperatively to 7.43° ± 1.23° postoperatively (t = 11.231, P < 0.001). No patients experienced anti-elevation syndrome (AES) or complications such as reverse head tilt postoperatively.

Conclusion: IOBT combined with contralateral inferior oblique recession could effectively treat asymmetric IOOA in patients with ocular asymmetry.

Keywords: Inferior oblique belly transposition; Inferior oblique muscle overaction; V-pattern exotropia.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of Jinan Second People’s Hospital, and all procedures adhered to the principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants and their parents or guardians prior to participation, confirming their understanding and agreement with the study procedures. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Photographs illustrating the inferior oblique button tuck (IOBT) procedure (right eye, surgeon’s view). (A) A 5 − 0 non-absorbable suture is pre-placed in the muscle belly, positioned 11 mm from the muscle insertion. (B) The belly of the inferior oblique muscle is secured to the sclera, 5 mm posterior to the temporal insertion of the inferior rectus muscle. (C) The suture (arrow) is fixed 5 mm posterior to the temporal side of the inferior rectus muscle
Fig. 2
Fig. 2
Schematic diagram of the right eye illustrating the IOBT procedure. The IOBT involved pre-placing sutures using 5 − 0 non-absorbable thread at a point 10–12 mm from the insertion of the inferior oblique muscle. The sutures were then anchored to the superficial sclera, 5 mm posterior to the temporal end of the inferior rectus muscle
See this image and copyright information in PMC

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