Superior oblique tuck: evaluation of surgical outcomes

To report the surgical outcomes of the superior oblique tuck procedure in the management of superior oblique palsies performed at a single centre over a 25-year period.

A retrospective study of superior oblique tuck performed as a primary and secondary procedure by a single surgeon over a 25-year period between 1992 and 2016. We evaluated patient demographics, the angle of deviation pre- and post-surgery in prism dioptres (PD), amount of muscle tuck surgery performed (mm), complications (iatrogenic Brown's Syndrome) and improvement of diplopia post-operatively.

162 eyes from 162 patients were identified. Gender = 108 male patients (66.67%). Mean age at the time of surgery = 45.94 years; laterality = 85 left eyes (52.47%). 110 patients (67.90%) = congenital superior oblique palsy. Mean post-op follow-up time = 7.5 months. Mean pre-operative angle of deviation = 15.88 PD (range = 4-35 PD); mean post-operative angle of deviation = 5.09 PD (range = 0-20 PD; p < 0.0001). 157 patients (96.91%) displayed a reduction in angle of deviation post-operatively. Overall mean reduction in the angle of deviation = 10.79 PD (range = 0-34 PD). Mean amount of muscle tucking = 9.75 mm (range = 3-20 mm). 24 patients (14.82%) experienced post-operative iatrogenic Brown's syndrome but only two of these required further corrective surgery. 138 patients (85.19%) experienced improvement of diplopia post-operatively. Overall, 54 patients (33.33%) required additional extraocular muscle surgery to reduce diplopia further.

This large series of superior oblique tuck procedures performed over a 25-year period, displays excellent surgical outcomes with regards to reduction of the angle of deviation, diplopia and limited complications.