Bilateral anterior transposition of the inferior obliques.

Sixty-one children with bilateral overaction of the inferior oblique muscle with concurrent or previous infantile esotropia received bilateral inferior oblique recessions with anteriorization to a point 2 to 4 mm anterior to the lateral end of the inferior rectus insertion. Subsequent reoperation for recurrent overaction of the inferior obliques was needed in only one case. Also, substantial reduction in dissociated vertical deviation (DVD), when present, and almost complete absence of subsequent need for surgery for DVD among the 61 children of this series were new findings. Only one of the 61 required subsequent surgery for manifest DVD. In another series of 60 infantile esotropes of similar ages drawn from the same practice who had previously had no inferior oblique surgery, nine needed surgery for DVD. This difference (one of 61 vs nine of 60) was significant.