The effect of surgical treatment of superior oblique muscle palsy on ocular torsion.

PURPOSE

To compare the effectiveness of superior oblique tuck and inferior oblique weakening procedures on objective and subjective torsion in patients with superior oblique palsy.

METHODS

Patients with unilateral superior oblique palsy evaluated between September 2007 and October 2009 were treated with one of four surgical procedures on the basis of their preoperative findings: superior oblique tuck, anterior transposition of the inferior oblique muscle, inferior oblique recession, or inferior oblique myectomy. Subjective (double Maddox rods) and objective (fundus photography) torsion were measured pre- and postoperatively.

RESULTS

A total of 28 patients were evaluated (mean age, 16.4 ± 12.4 years; range, 6-51 years). In 15 (53.6%) the superior oblique palsy was congenital; in 13 (46.4%) it was acquired. The mean decrease in subjective extorsion was 6.2° ± 2.3° after superior oblique tuck, 2.3° ± 2.4° after anterior transposition of the inferior oblique, 1.3° ± 2.7° after inferior oblique recession, and 2.6° ± 4.7° after inferior oblique myectomy. Objective extorsion decreased by 5.8° ± 0.8°, 4.4° ± 1.7°, 3.1° ± 3.2°, and 3.4° ± 4.7°, respectively.

CONCLUSIONS

Superior oblique tuck appears to correct extorsion more effectively than inferior oblique surgery, but this may be an artifact of performing tucks in patients with greater initial extorsion. The small amount of extorsion correction was similar for all inferior oblique procedures.