Isolated superior oblique tucking: an effective procedure for superior oblique palsy with profound superior oblique underaction.

PURPOSE

To compare efficacy and complications of isolated unilateral superior oblique tucking in patients with unilateral superior oblique palsy (SOP).

METHOD

A retrospective analysis of 24 cases of unilateral SOP, 13 Acquired (group 1), and 11 Congenital (group 2), who underwent isolated unilateral superior oblique tuck over a 13-year period was performed.

RESULTS

The mean preoperative vertical deviation in primary gaze was 10 +/- 3 PD for group 1 and 12 +/- 5 PD for group 2 and mean vertical deviation in lateral gaze of affected superior oblique was 19 +/- 5 PD for group 1 and 21 +/- 9 PD for group 2. The mean postoperative vertical deviation in primary gaze for group 1 after a mean follow-up period of 15 +/- 21 months was 1 +/- 3 PD; for group 2 after a mean follow-up period of 17 +/- 13 months was 2 +/- 3 PD, and in lateral gaze of affected superior oblique was 3 +/- 5 PD for group 1 and 5 +/- 6 PD for group 2. The mean correction of vertical deviation in primary gaze at last follow-up was 8 +/- 2 PD for group 1 and 9 +/- 5PD for group 2 ( P > 0.05) and in the lateral gaze field of affected superior oblique muscle was 16 +/- 4 PD for group 1 and 15 +/- 5 PD for group 2 ( P > 0.05). The mean preoperative torsion was 9 +/- 4 degrees for group 1 and 9 +/- 2 degrees for group 2; mean postoperative torsion was 1.2 +/- 2.2 degrees for group 1 and 1 +/- 1 degrees for group 2. The mean torsion corrected for group 1 was 8 +/- 3 degrees and for group 2 was 8 +/- 2 degrees ( P > 0.05). Only one patient in group 1 and three patients in group 2 required reoperation to correct residual deviation. A mild postoperative limitation to elevation in adduction was seen in all cases but was asymptomatic and lessened over time.

CONCLUSION

Isolated unilateral superior oblique tucking corrected a large amount of the vertical deviation and torsion with minimal complications in selective patients of both congenital and acquired superior oblique palsy. Superior oblique tucking is a safe and effective procedure and can be considered in patients with SOP meeting selective criteria.