Inferior Oblique Muscle Anteriorization Versus Anteriorization and Resection in DVD With IOOA

Study Overview
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Brief Summary
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The goal of this clinical trial is to compare the results of two surgical modalities in patients with Dissociated vertical deviation with inferior oblique muscle overaction . The main questions it aims to answer are: How much does the magnitude of DVD improve after each modality? Is the IOOA eliminated? Participants will be divided into two equal groups; Researchers will compare the efficacy of symmetrical anteriorization of the inferior oblique and adding an additional rescetion to one eye in the second group to see which group had more signifcant reduction in the magnitude of DVD and IOOA.

Detailed Description
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A prospective study was performed on patients with bilateral symmterical dissociated vertical deviation(DVD) and bilateral inferior oblique muscle overaction (IOOA) in Cairo University hospitals starting from February 2018 through December 2021. Patients wetre included in the study if they had a minimum follow up period of 6 months. The study included 54 patients (108 eyes) with manifest DVD and IOOA in boths eyes. Patients were divided into two equal groups. The paitents in group 1 underwent symmetrical inferior oblique muscle anteriorization, while the patients in group 2 underwent ayymmetrical surgery , where inferior oblique anteriorization was performed in one eye the same manner is in group 1, and the eye with the larger deviation had an additional 3-5 mm rescetion of the inferior oblique muscle along with anteriorization according to the measured DVD difference between both eyes, whether less than or more than 5 prism diopters respectively.

Official Title
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Anteriorization of the Inferior Oblique Muscle Versus Anteriorization and Resection for Asymmetrical Dissociated Vertical Deviation With Inferior Oblique Muscle Overaction

Conditions
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Dissociated Vertical Deviation, Inferior Oblique Overaction

Intervention / Treatment
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* Procedure: Inferior oblique anteriorization
* Procedure: Inferior oblique anteriorization together with unliateral resction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Manifest DVD decompensated to a tropia with free ocular motility Cases with or without horizontal misalignment Cases with or without previous horizontal muscle surgery Exclusion Criteria: Incomitant, Paralytic or restrictive strabismus Eyes with previous inferior oblique muscle surgery Recurrent DVD after surgical treatment Eyes with previous scleral buckling for retinal deatchment

Ages Eligible for Study
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Minimum Age: 1 Year

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group 1 (Anteriorization group)<br>Symmetrical Anteriorization of the inferior oblique muscle | Procedure: Inferior oblique anteriorization<br>* symmterical anteriorization the the inferior oblique muscle 1 mm behind and lateral to the inferior rectus insertion<br>|
| Experimental: Group 2 (Resction group)<br>Asymmetrical Anteriorization of the inferior oblique muscle, where an additional resection of the inferior oblique was done for the eye with the larger deviation | Procedure: Inferior oblique anteriorization together with unliateral resction<br>* asymmterical surgery, anteriorization the the inferior oblique muscle 1 mm behind and lateral to the inferior rectus insertion in one eye, and an additional 3-5 mm resction of the inferior oblique in the eye with the larger devation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| reduction of the magnitude of DVD | degree of reduction of the deviation measured in prism diopters | 1 week ,1 month, three months, six months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| reduction of magnitude of IOOA | redctuon in the measured degree of IOOA | 1 week ,1 month, three months, six months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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DVD, IOOA, IO Anteriorization, IO Anteriorization with rescetion