Factors associated with inferior oblique transposition surgery and occurrence of anti-elevation syndrome
Reviewed by Fiona Rowe

The purpose of this study was to correlate the frequency of anti-elevation syndrome (AES) with the magnitude of the anterior transposition of the inferior oblique. This was a retrospective study of 312 eyes of 170 patients. Mean age at surgery was 12.13 ±10.37 years with mean follow-up of 7.4 ±3 months. Horizontal deviation in primary gaze was present in 92% with a 2:1 esotropia:exotropia ratio. The remaining 8% had no horizontal deviation in primary gaze. Dissociated vertical deviation was present in 43%, 28% had V pattern with inferior oblique overaction, and 29% had both. The results showed the more anterior the insertion of the transposed inferior oblique, and the greater its lateral spread, the greater the incidence of AES. Placement of the inferior oblique insertion to create a J deformity, placement adjacent to the temporal border of the inferior rectus, and suturing the new insertion more anteriorly than 2mm posterior to the temporal border of the inferior rectus led to increased occurrence of AES. There were no significant associations with surgical technique. This study provides useful information on potential avoidance of AES with inferior oblique transposition surgery.

Anterior transposition of the inferior oblique and anti-elevation syndrome – how far to go?
Darcie ALF, Debert I, de Assis Bernardes RO, et al.
STRABISMUS
2024;32(2):81–4.