Outcome of management of inferior oblique inclusion syndrome associated with recurrent strabismus

Purpose: To evaluate outcome and describe the management of inferior oblique inclusion associated with recurrent strabismus. Methods: Twenty two patients reoperated upon lateral rectus muscles for correction of horizontal deviation (residual or recurrent exotropia or esotropia) with abnormal vertical deviation (hypotropia or hypertropia) that suspect inferior oblique inclusion or diagnosed during reoperation. Each patient was managed with release of inferior oblique along with appropriate horizontal muscle surgery. Results: After release of the inferior oblique muscle the vertical deviation reduced in primary positions from 15±7.3 PD to 7.5 ±4.3 (P<0.001) in patients with hypotropia and from 16±6.3PD to 8.5 ±3.6 (P<0.001) in patients with hypertropia, with stability of ocular alignment for a minimum of 6 months. Inferior oblique muscle was released only without recession or anteriorization in 8 patients (36.2%) and recessed from1mm to 4mm in 7patients (31.8%) and anteriorization was done in 7 patients (31.8%). Conclusion: Release of inferior oblique from lateral rectus had good favorable outcome was achieved only in cases with partial inclusion with low scores of fibrosis. Limitation of vertical movement could not be completely resolved in cases with total inclusion with marked fibrosis. Inferior oblique inclusion is preventable complication if taken in consideration during surgery on the lateral rectus muscle.