Superior oblique tendon resection or inferior oblique muscle recession in vertical deviations

This study reports the results on patients undergoing superior oblique (SO) tendon resections with or without inferior oblique (IO) muscle recession to correct vertical deviations. The design of this study was nonrandomized, baseline-controlled, and postsurgical versus presurgical and was performed in a solo practice affiliated with a university ophthalmology department. One hundred ninety-five patients underwent surgery. Patients were evaluated presurgically and postoperatively in the major fields of muscle action. Resections were based on measurements at 14 inches in the field of major function of the SO. The surgical approach was a radial, rather than circumferential, incision extending from the limbus to the tarsus parallel to the lateral border of the superior rectus, followed by resection of the SO tendon. Surgery resulted in improved fusion in 78% of the cases. Average deviation in the left superior oblique field in SO tendon resection only (n = 14) was reduced from 11.0 to 1.7 prism diopters, and fusion improved 85% after treatment. In 181 cases of SO tendon resection or IO recession, the left superior oblique field was reduced from 15.8 to 3.6 diopters. SO tendon resection was successfully utilized to treat underacting SO muscle and vertical deviations. A radial incision facilitated the surgical procedure, and its use is recommended to those performing the surgery.