Inferior myectomy vs inferior oblique anterior transposition for superior oblique palsy management
Reviewed by Fiona Rowe

The aim of this study was to compare surgical results of inferior myectomy (IOM) and inferior oblique anterior transposition (IOAT), and postoperative complications, in patients with unilateral superior oblique palsy. This was a retrospective study of 124 patients with mean age of 13.87 ±11.82 years (male: female ratio of 1.03). The cause was congenital in 89% and acquired in the remainder (trauma and neurological). Acquired cases were older and had more cases with diplopia. Knapp classification was type 1 or 3; all had inferior oblique overaction. There was no tendon lax on intraoperative evaluation. Surgery was IOM in 55.5% and IOAT in 45.5%. Follow-up was for a period of 16.25 ±19.2 months (minimum of 6 months). There were no significant differences in groups for age, sex, eye, cause and amblyopia. Primary preoperative measurements were 11–20PD hypertropia; mean 15.35 ±2.77. Hypertropia was significantly greater in the IOAT group. Postoperative mean hypertropia was lower in the IOAT group, but not significantly. IOAT cases had greater hypertropia correction in primary gaze, contralateral gaze and ipsilateral tilt positions. Abnormal head posture was present in 76% which resolved for 66%. In the IOM group, 72.5% achieved ortho vs 62% in the IOAT group. The authors conclude, for unilateral superior oblique palsy, hypertropia correction is significantly more with IOAT than IOM. Both procedures are equally effective for moderate angles but IOAT is better for reduction of larger hypertropia deviations >16PD, with better rate of under-correction and need for reoperation.

Inferior oblique muscle myectomy vs anterior transposition in the management of unilateral superior oblique muscle palsy: a comparative study.
Farvardin H, Ebrahimi F, Farvardin H, et al.
STRABISMUS
2025;33(4):229–38.