Small tuck for superior oblique palsy.

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Pediatric Ophthalmology

Background:

• Unilateral superior oblique (SO) palsy can cause significant vertical deviations and incomitance.
• Surgical correction aims to restore binocularity and reduce symptoms like diplopia.
• The efficacy of small SO tucks in cases with minimal tendon laxity is not well-established.

Purpose of the Study:

• To evaluate the surgical outcomes of small superior oblique (SO) tuck procedures in patients with unilateral SO palsy.
• To assess the effectiveness of SO tuck in correcting hypertropia and lateral incomitance.
• To determine if small SO tucks are a viable option for SO palsy even without significant tendon laxity.

Main Methods:

• Retrospective review of 27 patients who underwent ≤6 mm SO tuck for unilateral SO palsy between 2000 and 2018.
• SO tucks were performed to eliminate tendon slack.
• Pre- and postoperative motility measurements were compared; patients with prior strabismus surgery or concurrent vertical muscle surgery were excluded.

Main Results:

• Median hypertropia decreased from 9Δ to 1Δ in primary position and 20Δ to 4Δ in the SO field of action.
• Lateral incomitance reduced from 10Δ to 2Δ (P < 0.001).
• Six patients experienced mild, asymptomatic upgaze diplopia; six required further surgery for residual hypertropia.

Conclusions:

• Small SO tucks provide significant correction of hypertropia, particularly in the SO field of action.
• This technique effectively reduces lateral incomitance without inducing significant iatrogenic Brown syndrome.
• SO tuck is a beneficial surgical option for SO palsy, especially when marked lateral incomitance is present, even without obvious tendon laxity.