[Shift of the insertion of the superior oblique muscle by scleral buckling: clinical features and surgery].

A 36-year-old man who had been operated on for left eye retinal detachment (silastic sponge, secondarily explanted), presented with an 18 PD left hypertropia in primary position, to a 40 PD hypertropia in abduction, with downgaze limitation, associated with esotropia and incyclotorsion. Surgical exploration showed extensive tissue scarring and fibrosis in the area of the superior rectus and the superior oblique muscles. The insertion of the superior oblique was found in the superomedial quadrant, very anteriorly from the equator of the eye, which made it an elevator and an adductor of the globe. The pathophysiology and the surgical planning are discussed.