Traumatic tear of the inferior rectus muscle treated with inferior oblique anterior transposition.

Int Ophthalmol 2005 Aug-Oct;26(4-5):185-9. Epub 2007 Feb 8.

Henry C. Witelson Ocular Pathology Laboratory, Department of Ophthalmology, McGill University, Lyman Duff Building, 3775 University Street, Room 216, Montreal, QC, Canada, H3A 2B4.

Purpose: To report a case of traumatic tear of the inferior rectus muscle treated with inferior oblique anterior transposition (IOAT).

Methods: Case report of a 55-year-old man who presented with vertical diplopia (VD) after orbital trauma. Ocular examination disclosed a 62PD right hypertropia (RHT) in the primary position (PPO). The right inferior rectus (RIR) was torn, and the distal stump was fixed to the skin with tape.

Results: Surgery was performed under local anesthesia. The RIR tearing occurred 13 mm from the insertion, and exploration revealed its proximal end. The right inferior oblique (RIO) was intact, although its fibers were loose. Since the RHT did not improve following reattachment of the proximal and distal stumps of the RIR, the distal stump was excised and the proximal end brought forward and sutured 6.5 mm from the limbus. At perioperative evaluation, there was a 25PD RHT in PPO where the VD persisted. The RIO was subsequently isolated, detached, and its distal end, after 6 mm resection, was sutured to a point temporal to the lateral border of the RIR. The patient was reevaluated and had neither RHT nor VD in primary gaze. At the 6-week postoperative evaluation, he was orthotropic in PPO, complaining about diplopia only on extreme downgaze. A mild limitation of right depression was observed. The patient was satisfied with the surgical results and experienced no functional limitations during any activities.

Conclusion: IOAT can provide acceptable binocular visual function without the risk of anterior segment ischemia in cases of torn inferior rectus muscle.

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May 2007
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