VideoFrom OSN Europe

VIDEO — Inferior oblique fadenoperation: A new weakening technique

This video, first-prize winner at the European Meeting of Young Ophthalmologists, shows a new weakening technique used by the authors, Gonzalo García de Oteyza, MD, and Juan García de Oteyza, MD, PhD, to treat inferior oblique overaction.

“This technique is reversible and efficient and avoids some of the complications that can be found after the inferior oblique gold standard technique, such as antielevation syndrome, inferior oblique adherent syndrome or vortex vein injury,” Gonzalo García de Oteyza said.

These are the surgical maneuvers, step by step, as suggested by the authors:

  • Perform radial peritomy in the space between the inferior rectus and lateral rectus.
  • Hook the inferior oblique muscle and check that the whole body muscle is included (a white triangle must be seen).
  • Expose the muscle correctly.
  • Embrace the inferior oblique muscle with a non-reabsorbable suture such as Dacron 5-0.
  • Tighten a knot as medially as possible for shortening the length of the muscle.
  • Anchor the muscle at 8 mm from the lateral end of the inferior rectus, leaving it in a post-equatorial position.
  • Suture the conjunctiva.

This procedure holds many advantages, Gonzalo García de Oteyza said.

“First of all, we are giving a new functional insertion to the muscle without changing the anatomy because we are not disinserting the scleral insertion. This technique is acting as if we had done a recession plus resection technique (fadenoperation) and we leave the muscle in a retroequatorial position, considerably reducing the possibility of antielevation syndrome. We also reduce the iatrogenic risk of injuring the macula and the vortex vein,” he said. Six patients were successfully treated with this procedure. The inferior oblique overaction was reduced in all cases, and no intraoperative or postoperative complications occurred. – by Michela Cimberle

For more information:

Gonzalo García de Oteyza, MD, president of the Spanish Society of Young Ophthalmologists, practices at Clínica García de Oteyza, Barcelona, Spain. He can be reached at email: gonzalo_gdeoteyza@hotmail.com.

Juan García de Oteyza, MD, PhD, strabismus and pediatric ophthalmology specialist, practices at Clínica García de Oteyza, Barcelona, Spain. He can be reached at email: 7733jgf@comb.cat.

Disclosures: Gonzalo García de Oteyza, MD, and Juan García de Oteyza, MD, PhD, report no relevant financial disclosures.

This video, first-prize winner at the European Meeting of Young Ophthalmologists, shows a new weakening technique used by the authors, Gonzalo García de Oteyza, MD, and Juan García de Oteyza, MD, PhD, to treat inferior oblique overaction.

“This technique is reversible and efficient and avoids some of the complications that can be found after the inferior oblique gold standard technique, such as antielevation syndrome, inferior oblique adherent syndrome or vortex vein injury,” Gonzalo García de Oteyza said.

These are the surgical maneuvers, step by step, as suggested by the authors:

  • Perform radial peritomy in the space between the inferior rectus and lateral rectus.
  • Hook the inferior oblique muscle and check that the whole body muscle is included (a white triangle must be seen).
  • Expose the muscle correctly.
  • Embrace the inferior oblique muscle with a non-reabsorbable suture such as Dacron 5-0.
  • Tighten a knot as medially as possible for shortening the length of the muscle.
  • Anchor the muscle at 8 mm from the lateral end of the inferior rectus, leaving it in a post-equatorial position.
  • Suture the conjunctiva.

This procedure holds many advantages, Gonzalo García de Oteyza said.

“First of all, we are giving a new functional insertion to the muscle without changing the anatomy because we are not disinserting the scleral insertion. This technique is acting as if we had done a recession plus resection technique (fadenoperation) and we leave the muscle in a retroequatorial position, considerably reducing the possibility of antielevation syndrome. We also reduce the iatrogenic risk of injuring the macula and the vortex vein,” he said. Six patients were successfully treated with this procedure. The inferior oblique overaction was reduced in all cases, and no intraoperative or postoperative complications occurred. – by Michela Cimberle

For more information:

Gonzalo García de Oteyza, MD, president of the Spanish Society of Young Ophthalmologists, practices at Clínica García de Oteyza, Barcelona, Spain. He can be reached at email: gonzalo_gdeoteyza@hotmail.com.

Juan García de Oteyza, MD, PhD, strabismus and pediatric ophthalmology specialist, practices at Clínica García de Oteyza, Barcelona, Spain. He can be reached at email: 7733jgf@comb.cat.

Disclosures: Gonzalo García de Oteyza, MD, and Juan García de Oteyza, MD, PhD, report no relevant financial disclosures.