To evaluate the results of unilateral inferior oblique anterior transposition (IOAT) for markedly asymmetric dissociated vertical deviation (DVD) combined with inferior oblique over-action (IOOA). Retrospective chart review of the records of all patients with asymmetric DVD combined with unilateral IOOA in the non-dominant eye who received unilateral IOAT on the non-dominant eye. No other muscles were operated on simultaneously. The amount of DVD and IOOA were measured before and after the operation and statistically analysed. Seventeen patients were included. The mean age at surgery was 23.5?±?8.4 (range 12–38) years old. The mean postoperative follow-up period was 15.7?±?7.2 (range 6–32) months. The primary position DVD was 19.6?±?5.4 (range 14–36) PD preoperatively and decreased significantly to 2.9?±?2.0 (range 0–8) PD postoperatively (P??0.01). Preoperatively, there were 2, 7, and 8 patients with +?1, +?2, and?+?3 IOOA, respectively, and these were reduced from 2.4?±?0.7 to 0.3?±?0.4 postoperatively (P??0.01). None of the patients were complicated obvious hypotropia, anti-elevation syndrome or IOOA in the contralateral eye. Unilateral IOAT was recommended in patients with asymmetric DVD coexists with unilateral IOOA.
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