The long-term surgical outcomes for the treatment of inferior oblique overaction: a retrospective single-center study

Abstract

This study aims to evaluate the long-term surgical outcomes in patients with inferior oblique overaction (IOOA). The medical records of 106 patients who underwent inferior oblique weakening surgery, with a minimum follow-up of one year, were retrospectively analyzed. Surgical success was determined by motor outcomes, abnormal head posture (AHP) improvement, and postoperative satisfaction. At one year postoperatively, 82.8% of patients with preoperative HT of less than 5 prism diopters (PD) showed resolution of over-elevation in adduction, while 71.4% of those with HT ≥ 5 PD achieved HT reduction. Improvement in AHP was observed in 76.4% of patients, and 72% reported postoperative satisfaction. Reoperation was required in 30.2% of the total, primarily due to residual HT or head tilt. After reoperation, success rates improved to 86.8% for motor outcomes and AHP improvement, with 89.6% reporting satisfaction. Multivariate analysis revealed follows (all p < 0.05): severity of preoperative head tilt and IOOA amount increased the risk of poor motor outcomes; degree of preoperative head tilt was associated with residual AHP; age at time of IO surgery and preoperative head tilt degree were associated with postoperative dissatisfaction, and younger age at surgery increased the likelihood of reoperation.