Cyclotorsional diplopia following retinal detachment surgery.

Four patients reporting symptoms of torsional diplopia following retinal detachment repair were seen. One patient most likely had a pre-existing, partially compensated superior oblique palsy as the cause of her vertical deviation and excyclotorsion. A second was found to have the superior oblique tendon adherent anteriorly to the encircling band and buckle just behind the superior rectus insertion, resulting in incyclotorsion. Release of these restrictions reduced the torsion to a small, asymptomatic degree. The third and fourth patients had excyclotorsion for unexplained reasons. Removing the scleral exoplant and Harada-Ito type surgery on the superior oblique tendon did not relieve the symptoms and only minimally reduced the excyclotorsion in one patient. A second procedure, with advancement of the anterior portion of the superior oblique tendon, successfully eliminated cyclotorsional symptoms.