IO surgery
Reviewed by Fiona Rowe

The purpose of this paper was to evaluate the efficacy of a new surgical technique in reducing inferior oblique muscle overaction (IOOA) consisting of suturing the muscle to the sclera at the Gobin point with tendon sparing and using a micro incision to minimise related tissue trauma. Eight patients aged 5-51 years were included. At four months postoperative the mean angle reduced to 8PD exotropia in five patients with a V-exotropia. One patient with unilateral IOOA had reduced from 18 to 3PD vertical deviation. Two patients with infantile esotropia had complete resolution of elevation in adduction with no vertical imbalance. All had improvement in lateral incomitance. The authors propose the technique as simple, safe, reversible and modular in terms of suturing. They propose additional benefits of little risk to developing vorticose haemorrhage or macular damage, no errors in IO muscle hooking and no risk of anti-elevation syndrome. 

New surgical intervention for the weakening of the inferior oblique muscle: equatorial scleral anchor.
Tomarchio S, Sabetti L, Tomarchio M, Berarducci A.
JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2015;52:58-60.