Primary-position hypotropia after anterior transposition of the inferior oblique
D. L. Bremer, G. L. Rogers and L. D. Quick
Three patients with fourth cranial nerve palsy underwent a recession of the
ipsilateral inferior oblique muscle. In all three cases, the inferior
oblique muscle was anteriorly displaced to the temporal border of the
inferior rectus muscle. In the immediate postoperative period, all three
patients developed a hypotropia and diplopia in the primary position with
limitation of upgaze. The hypotropia remained stable and required
retrodisplacement of the inferior oblique muscle in order to eliminate the
diplopia. We emphasize the power of the anterior transposition of the
inferior oblique muscle and caution its use as a unilateral procedure in
patients with central fusion.
