Intraoperative adjustable suture surgery for excyclotorsion: a modification of the harada-ito procedure

This study evaluated the surgical results of intraoperative adjustable tucking of the anterior portion of the superior oblique tendon for treatment of excyclotorsion. Two cases of acquired bilateral superior oblique palsy with symptomatic excyclotorsion and minimal vertical deviation in primary position were considered. Tucking of the anterior one-third of the superior oblique tendon was performed with a nonabsorbable suture. The amount of tuck was adjusted until the fovea was at the level of the superior one-third of the disc through indirect ophthalmoscopy. In the patient with local anesthesia, a double Maddox rod test was used to evaluate subjective cyclotorsion intraoperatively. After surgery, the patients became symptom-free. No regression toward excyclotorsion was noted during 18 months of follow-up. Tucking of the anterior portion of the superior oblique tendon is an effective procedure for improving symptomatic excyclotorsion in patients with bilateral superior oblique palsy without significant vertical deviation in primary position.