Dr. SASIKALA ELIZBETH ANILKUMAR

Dr. SANDRA CHANDRAMOULI, Dr. KALPANA NARENDRAN

Abstract

Anterior transposition of the IO is the standard procedure for DVD with IOOA. ANT of IO is a newer procedure. We report a case of 20 yr old lady with residual esotropia, DVD & IOOA(3+). She had 60 PD ET, 20 PD RE DVD and 3 PD LE DVD in primary position. She underwent horizontal rectus muscle surgery and ANT of IO such that the posterior fibers were reattached 1 mm nasal to the nasal border of IR insertion and then the anterior fibers were reattached 3 mm nasal to the first suture. Postop orthotropic, 4 PD E’ and 3 PD DVD in both eyes in primary position & showed resolution of DVD and IOOA providing an excellent motor outcome. Fard et al showed, preop >15PD DVD, 53% had an excellent outcome and 47% had a fair outcome with ANT. 3 had under elevation in adduction. Farid et al 37.5% had an excellent outcome with ANT for similar DVD. Postop hypotropia and IO underaction can be expected with ANT. ANT of IO can be considered as a safe option for large DVD with IOOA with minimal complications