Purpose: To compare the effects of graded ANTERIOR TRANSPOSITION with myectomy in primary inferior oblique overaction (IOOA). Methods: In a randomized clinical trial study, patients entered into two groups: graded ANTERIOR TRANSPOSITION (Group 1) and myectomy (Group 2). In the myectomy method, 8 mm of the inferior oblique (lO) muscle was excised in the lower temporal side, and in the graded ANTERIOR TRANSPOSITION group, the IO muscle was recessed according to Wright's method. Patients were followed up for at least 1. 5 months. IOOA was graded from 0 to þ 4. Surgical success was defined as reduced IOOA to a grade of þ 1 or less. Results: In a randomized clinical trial study, a total of 30 patients (60 eyes) were included in the study (32 eyes in Group 1 and 28 eyes in Group 2). Pre-operation IOOA was 3. 18 ± 0. 78 and 3. 25 ± 0. 70 in Groups 1 and 2, respectively. Mean IOOA in Group 1 and 2 was 0. 95 ± 0. 24 and 0. 40 ± 0. 10 at 6 months after the surgery, which means the mean correction of the overaction was statistically significant in both methods (P < 0. 001). The success rate in the myectomy procedure was higher than graded recession. The weakening effect was better in higher grades of overaction (P < 0. 001). The overall success rate of Groups 1 and 2 was 75% and 96. 4%, respectively (P ¼ 0. 029). Conclusions: In both groups, IOOA significantly decreased after the operation. The success rate of the myectomy procedure was found to be significantly higher than graded ANTERIOR TRANSPOSITION.

Purpose: To compare the efficacy of inferior oblique myectomy and ANTERIOR TRANSPOSITION for correcting Inferior Oblique Over Action (IOOA) and DVD.Methods: This retrospective study was carried out on patients with IOOA who had either myectomy or ANTERIOR TRANSPOSITION of the inferior oblique muscle from 2010 to 2015. The authors compared pre-operative and post-operative inferior oblique muscle function grading (-4 to+4) as the main outcome measure; vertical and horizontal deviation, dissociated vertical deviation (DVD), and A V-pattern between the two surgical groups as secondary outcomes.Results: A total of 99 eyes of 56 patients with a mean age of 5.9 ± 6.5 years were included (47 eyes in the myectomy group and 52 eyes in the ANTERIOR TRANSPOSITION group). There were no differences in preoperative best corrected visual acuity, amblyopia, spherical equivalent, and primary versus secondary IOOA between the two groups. Both surgical procedures were effective in reducing IOOA and satisfactory results were similar between the two groups: 61.7% and 67.3% in the myectomy and ANTERIOR TRANSPOSITION groups, respectively (P=0.56). After adjustment for the pre-operative DVD, there was no statistically significant difference between the two groups post-operatively. The pre-operative hypertropia was 6 to 14 and 6 to 18 prism diopters (PD) in the myectomy and ANTERIOR TRANSPOSITION groups, respectively. After surgery, no patient had a vertical deviation greater than 5 PD.Conclusion: Both the inferior oblique myectomy and ANTERIOR TRANSPOSITION procedures are effective in reducing IOOA with similar satisfactory results. DVD and hypertropia were also corrected similarly by these two surgical procedures.

Purpose: To evaluate the results of ANTERIOR and nasal TRANSPOSITION (ANT) of the inferior oblique muscle (IO) in patients with the lO muscle overaction.Methods: This retrospective case series included patients with lO muscles overaction, in whom ANT of the lO muscle was performed. In patient with simultaneous horizontal deviation, horizontal strabismus surgery was also performed. They were evaluated pre- and post-operatively for alignment and oculomotor examination.Results: Seven patients with the mean age of 9.2±5.2 years were included for the study. Unilateral and bilateral ANT was performed in one and 6 patients respectively. Patients were followed for a mean of 32.5±9 months. lO muscle overaction was eliminated in all patients. Antielevation syndrome was developed in 2 patients. One patient needed further operation for residual horizontal deviation.Conclusion: It seems that ANT is useful for the treatment of patients with the lO overaction. However, the risk of antielevation syndrome should be considered.

Purpose: ANTERIOR TRANSPOSITION of the inferior oblique muscle was reported to be an effective treatment for dissociated vertical deviation (DVD), Our aim is to evaluate the efficacy of this surgical procedure in a series of patients with DVD alone and DVD with concurrent overactive inferior oblique muscle and to compare the results. Method: Nineteen eyes with DVD only (group one) and fifteen eyes with DVD and concurrent inferior oblique overaction (group two) underwent IOAT. The amount of DVD and inferior oblique overaction (IOOA) before and after the operation was registered and statistically analyzed. Results: The mean follow up time for the first and the second groups were 9.4 and 9 months respectively. Overall in five of seven eyes with DVD of more than 15PD, the residual DVD following the operation were more than five PD .Whereas in the 27 patients with DVD less than or equal to 15 PD the residual deviation were below 5PD (P value=0.014). Conclusion: IOAT is an effective method for correcting DVD with and without IOOA especially in deviations under 15 PD. In DVD> 15 PD it seems that IOAT alone is unable to correct or reduce DVD satisfactorily.      

In this paper we introduce the notions of fuzzy TRANSPOSITION hyper groups and fuzzy regular relations and investigate their basic properties. We also study fuzzy quotient hyper groups of a fuzzy TRANSPOSITION hyper group.

Purpose: Comparison of Parks and Kennet Wright procedure for ANTERIOR TRANSPOSITION of inferior oblique muscle regarding the incidence of antielevation syndrome. Method: Twenty-four patients underwent graded ANTERIOR TRANSPOSITION of the IO muscle for inferior oblique overaction (12 cases for each procedure). Results: Two out of 12 (16%) patients were complicated by antielevation syndrome in Parks procedure. There was no instance of this syndrome in Kennet Wright procedure. Conclusion: Our study provides preliminary evidence in support of superiority of Kennet Wright procedure over Parks procedure. Further large scaled studies are needed to document the exact difference.

Purpose: To determine the effectiveness of ANTERIOR TRANSPOSITION of the inferior oblique muscle for treatment of superior oblique palsy in patients with 16-25 PD of hypertropia in primary position.Material and methods: Twenty patients with unilateral superior oblique palsy, underwent ANTERIOR TRANSPOSITION of the inferior oblique muscle. A modification of the surgical technique of Elliott and Nankin was used. The alternate prism cover test measurements were made in all cardinal positions of gaze before and six months after surgery.Results: Mean reduction of hypertropia after surgery was 18.6 PD in primary position, 24 PD in adduction, 28.5 PD in elevation and adduction, and 20.1 PD in depression and adduction. Postoperative hyperdeviation in primary position was 5 PD or less in 19 patients. There was no hypotropia in primary position. Mild limitation of upgaze was found in 20% of the patients and the same number developed mild fullness of the lower lid.Conclusion: ANTERIOR TRANSPOSITION of the inferior oblique muscle is very effective in eliminating the hyperdeviation of patients with 16-25 PD hypertropia in primary position due to superior oblique palsy. Its complications are mild and insignificant.

Background - Weakening of the inferior oblique muscle is the procedure of primary importance in the treatment of patients with superior oblique palsy, Knapp s classes 1 and III. In this study, the effectiveness of ANTERIOR TRANSPOSITION of the inferior oblique muscle in the treatment of these patients was evaluated. Methods - Twenty three patients with superior oblique palsy, Knapp s classes I and III underwent ANTERIOR TRANSPOSITION of the inferior oblique muscle. These patients had 10 to 25 prism diopters (PD) hyperdeviation in primary position. The tip of the disinserted muscle was sutured to the sclera parallel and adjacent to the lateral border of the inferior rectus muscle insertion. The prism and alternate cover test measurements were performed in all cardinal positions of gaze before and six months after surgery. Results - The mean reduction of hyperdeviation measured 14.9 PD in the primary position, 23 PD in adduction, 25.2 PD in elevation and adduction, and 18.1 PD in depression and adduction. There was no hypotropia in the primary position or limitation of upgaze. Postoperative hyperdeviation in the primary position was 5 PD or less in 21 out of 23 patients. Conclusion - The ANTERIOR TRANSPOSITION of the inferior oblique muscle is very effective in eliminating hyperdeviation in patients with superior oblique palsy, Knapp s classes I and Ill. Up to 25 PD of hyperdeviation reduction in the primary position can be achieved. If this type of ANTERIOR TRANSPOSITION is used, hypotropia in the primary position or limitation of upgaze will possibly not occur.