[The surgical treatment of superior oblique paralysis (author's transl)]

The line of treatment drawn out by Malbran more than 20 years ago has lost none of its standing. However, although the main principles are still valid, the surgical protocol should be modified in view of the evolution of the surgical concept and technique for which we are indebted to Cüppers. The so-called "thread operation", which the author proposes to call the "Retroequatorial Myopexy of Cüppers" brings a decisive progress. Combined with the primary effect on the paralysis muscle, it also elegantly solves the three problems of this paralysis, namely hyperphoria, excyclophoria, and muscular incomitance. The ideal surgical plan includes now a Superior Oblique Tuck of the affected muscle, with a Retroequatorial Myopexy of the Inferior Rectus of the sound eye, either in the same operation or separately. The muscle weakening procedures by the traditional recession should be avoided.