Impact of bilateral graded inferior oblique recession on ocular torsion in patients with primary inferior oblique overaction: A prospective study

Abstract

Introduction and objectives

The impact of inferior oblique (IO) weakening on ocular torsion is well documented. This study aimed to evaluate objective and subjective torsional changes using fondo photography and the Double Maddox rod test (DMRT) after bilateral IO recession in cases of primary inferior oblique overaction.

Materials and methods

This prospective, hospital-based observational cohort study included 82 eyes from 41 patients with primary inferior oblique overaction who underwent IO recession using the Apt and Call technique between December 2023 and March 2025. Pre- and postoperative subjective and objective torsion were analyzed using the DMRT and fundus photography to assess torsional changes at 1, 4, and 12 weeks.

Results

The mean age was 13.93 ± 8 years; 58.5% of patients were male. Preoperative DMRT showed no subjective torsion, with a mean objective torsion of 9.32 ± 5.25°. Mean IOOA grade and V-pattern were 2.74 ± 0.98 and 28.66 ± 9.08 prism diopters, respectively. Postoperatively, DMRT findings remained unchanged, whereas objective torsion decreased significantly to 5.82 ± 3.95, 5.51 ± 3.8, and 5.08 ± 3.77° at 1, 4, and 12 weeks, respectively. The overall change in torsion at 12 weeks was 4.24 ± 3.14°. Additionally, significant improvements in IOOA grading and V-pattern were observed at 12 weeks, with values of 0.09 ± 0.28 grades and 6.05 ± 2.95 prism diopters, respectively (P < .001).

Conclusions

Bilateral graded IO recession significantly reduces objective ocular extorsion, without a corresponding change in subjective torsion as assessed by DMRT. The reduction in torsion was accompanied by significant improvements in IOOA grading and V-pattern deviation, confirming the functional efficacy of IO recession.