Inferior oblique myectomy compared with inferior oblique recession for vertical strabismus in superior oblique palsy

Patient or population: people with symptom‐producing and/or socially noticeable unilateral overacting inferior oblique muscle; all participants had longstanding unilateral superior oblique underaction

Settings: eye hospital

Intervention: inferior oblique myectomy

Comparison: inferior oblique recession

Proportion of participants with postoperative surgical success (hypertropia less than 3 PD in primary gaze)

N/A

This outcome measure was not reported in the study included in this comparison. However, median hypertropia in primary gaze at 12 months was 3 PD in the myectomy group and 1 PD in the recession group. The average reduction in hypertropia in primary position was 14 PD in the myectomy group and 8 PD in the recession group (P = 0.042).

Proportion of participants with anomalous head position preoperatively with residual head tilt postoperatively

N/A

This outcome measure was not reported in the study included in this comparison.

Proportion of participants with postoperative hypertropia less than 3 PD in down gaze

N/A

This outcome measure was not reported in the study included in this comparison.

Proportion of participants with postoperative hypertropia less than 3 PD in contralateral gaze

N/A

This outcome measure was not reported in the study included in this comparison.

Proportion of participants who received additional strabismus surgery

N/A

None of the participants in either group required a second strabismus surgery during the follow‐up interval.

Proportion of participants with reversal of vertical deviation postoperatively

N/A

This outcome measure was not reported in the study included in this comparison.

Proportion of participants with postoperative orbital cellulitis

N/A

This outcome measure was not reported in the study included in this comparison.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of the effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of the effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of the effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

CI: confidence interval; N/A: not applicable; PD: prism diopters

Inferior oblique disinsertion compared with inferior oblique anterior transposition for vertical strabismus in superior oblique palsy

Patient or population: people with unilateral superior oblique palsy

Settings: eye hospital

Intervention: inferior oblique disinsertion

Comparison: inferior oblique anterior transposition

Proportion of participants with postoperative surgical success (hypertropia less than 3 PD in primary gaze)

Moderate

This outcome measure was not reported in the study included in this comparison. However, the mean reduction of hypertropia in primary position was 13.3 (SD 1.9) PD in the disinsertion group and 18.5 (SD 3.9) PD in the anterior transposition group (mean difference ‐5.20 PD, 95% CI ‐7.76 to ‐2.64). This difference favors inferior oblique anterior transposition.

Proportion of participants with anomalous head position preoperatively with residual head tilt postoperatively

Very low

This outcome favors inferior oblique anterior transposition.

Proportion of participants with postoperative hypertropia less than 3 PD in down gaze

N/A

This outcome measure was not reported in the study included in this comparison.

Proportion of participants with postoperative hypertropia less than 3 PD in contralateral gaze

Moderate

The mean reduction of hypertropia in adduction was 20.6 (SD 6.2) PD in the disinsertion group and 27.7 (SD 9.6) PD in the anterior transposition group (mean difference ‐7.10 PD, 95% CI ‐13.85 to ‐0.35). Anterior transposition resulted in a greater decrease in hypertropia in contralateral gaze, but it was unclear whether this difference favored the anterior transposition group, since the authors did not report the number of participants overcorrected in contralateral gaze.

Proportion of participants who received additional strabismus surgery

Very low

This outcome favors inferior oblique anterior transposition.

Proportion of participants with reversal of vertical deviation postoperatively

N/A

None of the participants in either group developed postoperative reversal of vertical deviation.

Proportion of participants with postoperative orbital cellulitis

N/A

This outcome measure was not reported in the study included in this comparison.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of the effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of the effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of the effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

CI: confidence interval; N/A: not applicable; PD: prism diopters; RR: risk ratio; SD: standard deviation