To the Editor.
—Your publication of "Primary-Position Hypotropia After Anterior Transposition of the Inferior Oblique" by Bremer et al1 was a genuine service. In September 1982,I presented three nearly identical cases to the Texas Society for Pediatric Ophthalmology. As in the three cases reported by these authors, the induced hypotropia in all three of my cases was eliminated by subsequent moreposterior placement of the previously anteriorized inferior oblique muscle.The observation by Bremer et al that there was no restriction to elevation on forced ductions at surgery is important, and their conclusion that the adherence syndrome was not involved matches my own observations in these patients at surgery. Anterior transposition of the inferior oblique muscle does appear to convert it from an elevator to a depressor, as noted by Dr Alan Scott (cited in the article by Bremer et al).This complication of unilateral anteriorization of the inferior oblique
Mims JL. Benefits of Bilateral Anterior Transposition of Inferior Obliques. Arch Ophthalmol. 1986;104(6):800-802. doi:10.1001/archopht.1986.01050180030016