Late overcorrection after inferior rectus recession.
OBJECTIVE
Describe characteristics and possible etiology of late overcorrection after inferior rectus recession in patients without Graves disease.


METHODS
Seven adult patients with initial good alignment (< 5 prism diopters) but an overcorrection 1 month after inferior rectus recession were studied.


RESULTS
Two patients had congenital superior oblique paresis, one had traumatic superior oblique paresis, two had orbital fracture, one had strabismus after retinal detachment surgery, and one had hypotropia after cataract surgery. Overcorrection occurred 4 to 6 weeks after surgery, measuring 12 to 25 prism diopters. Six patients with late overcorrection after inferior rectus recession underwent repeat surgery of the inferior rectus muscle. All six patients had scarring of the Lockwood ligament but no muscle slippage.


CONCLUSIONS
Late overcorrection can occur unrelated to Graves ophthalmopathy or a slipped muscle. Postoperative scarring around the Lockwood ligament was identified, which could result in reduced inferior rectus muscle force. It is hypothesized that late scar contracture in the vicinity of the Lockwood ligament could pull the inferior rectus muscle anteriorly, thus slackening the anterior aspect of the muscle. This slackening of the anterior aspect of the inferior rectus muscle would weaken the depression function, thus producing a late overcorrection.
Wright
K W
KW
Cleveland Clinic Foundation, OH 44195, USA.
D000328:Adult; D000368:Aged; D005128:Eye Diseases / Q000601:surgery; D005131:Eye Injuries / Q000150:complications; D005260:Female; D006801:Humans; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000209:etiology* / Q000473:pathology; D009801:Oculomotor Muscles / Q000473:pathology / Q000601:surgery*; D009886:Ophthalmoplegia / Q000209:etiology / Q000601:surgery; D009917:Orbital Fractures / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000473:pathology; D012086:Reoperation; D012189:Retrospective Studies; D013285:Strabismus / Q000209:etiology / Q000601:surgery