Journal of Pediatric Ophthalmology and Strabismus

Editorial 

Anterior Transposition of the Inferior Oblique for Dissociated Vertical Deviation

Leonard B Nelson, MD, MBA

Abstract

Anterior transposition of the inferior oblique tendon is a useful procedure not only to reduce overaction of the inferior oblique tendon, but also to treat concurrent dissociated vertical deviation (DVD). Advancing the inferior oblique tendon effectively converts the tendon to a depressor of the globe. In this issue of the Journal of Pediatric Ophthalmology dr Strabismus, Nabie et al. successfully show that the anterior transposition corrects DVD regardless of whether inferior oblique overaction is present. Three surgical approaches to treat DVD - recession of the superior rectus, recession of the superior rectus combined with a posterior fixation suture, and resection of the inferior rectus - have had enthusiastic proponents. The advantage of anterior transposition is that it can correct a concurrent overacting inferior oblique tendon as well. A potential benefit of this procedure is the prevention or substantial reduction of DVD. Because DVD occurs in a substantial number of children with congenital esotropia, performing this procedure on a child with an overacting inferior oblique tendon may reduce the incidence of DVD . This procedure certainly will reduce the overaction, and if it does reduce the incidence of DVD, it will ultimately prevent further surgery for the vertical deviation.…

Anterior transposition of the inferior oblique tendon is a useful procedure not only to reduce overaction of the inferior oblique tendon, but also to treat concurrent dissociated vertical deviation (DVD). Advancing the inferior oblique tendon effectively converts the tendon to a depressor of the globe. In this issue of the Journal of Pediatric Ophthalmology dr Strabismus, Nabie et al. successfully show that the anterior transposition corrects DVD regardless of whether inferior oblique overaction is present. Three surgical approaches to treat DVD - recession of the superior rectus, recession of the superior rectus combined with a posterior fixation suture, and resection of the inferior rectus - have had enthusiastic proponents. The advantage of anterior transposition is that it can correct a concurrent overacting inferior oblique tendon as well. A potential benefit of this procedure is the prevention or substantial reduction of DVD. Because DVD occurs in a substantial number of children with congenital esotropia, performing this procedure on a child with an overacting inferior oblique tendon may reduce the incidence of DVD . This procedure certainly will reduce the overaction, and if it does reduce the incidence of DVD, it will ultimately prevent further surgery for the vertical deviation.

10.3928/0191-3913-20070301-06

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