[Combined oblique muscle operation with transposition of the insertion in strabismus sursoadductorius]

The combined superior oblique tendon tuck and inferior oblique recession is the method of choice for the treatment of congenital and acquired superior oblique muscle palsies with large vertical and cyclodeviations. An additional transposition of the insertions is indicated if the vertical deviation differs greatly from the excyclodeviation.

38 patients who underwent combined oblique muscle surgery for congenital superior oblique muscle palsy were divided into 3 groups. Group A: 14 patients with small excyclodeviations in spite of large vertical deviations, even after diagnostic occlusion of 3 days. A superior oblique tendon tuck of 5 or 6 mm with transposition of the new insertion to the posterior margin of the original insertion was performed combined with a recession of the inferior oblique muscle of 5 or 6 mm with anterior displacement of 4-6 mm. Group B: 15 patients without a discrepancy between the vertical deviation and the cyclodeviation. They were treated with a conventional superior oblique tendon tuck of 5 or 6 mm combined with a recession of the inferior oblique muscle. Group C: 9 patients without a discrepancy between the vertical deviation and the cyclodeviation, but deviations smaller than in group B. A conventional superior oblique tendon tuck of 6 mm combined with a posterior tenotomy of the inferior oblique muscle was performed. The surgical effect was calculated as the difference between the preoperative deviation after diagnostic occlusion of 3 days and the postoperative deviations (1 week and 3 to 6 months). All angles of deviation were measured subjectively after dissociation of the binocular vision with a dark red filter in front of the fixating, not affected eye at 2.5 m distance using the Harms tangent screen.

3 months postoperatively, the vertical deviation was diminished in primary position by 12.1 degrees/6.8 degrees/6.8 degrees in groups A/B/C, in 25 degrees adduction of the affected eye by 18.4 degrees/13.8 degrees/9.5 degrees. The reduction of the cyclodeviation in primary position was 6.4 degrees/8.0 degrees/5.6 degrees. As a side effect a clinically insignificant, consecutive Brown syndrome occurred in each group. In each group a significant positive correlation between the preoperative deviation and the surgical effect was found.

The combined superior oblique tendon tuck and inferior oblique recession with transposition of the insertions is a suitable method for a selective treatment of the vertical deviation and the cyclodeviation in congenital superior oblique palsy.