Detached superior rectus following scleral buckling: anatomy and surgical management

We describe two patients who developed vertical diplopia following circumferential scleral buckling for retinal detachments. Both were found to have hypodeviation and impaired elevation of the operated eye. In each case this was initially ascribed to the presence of the buckle itself, but there was no clinical improvement when this was subsequently removed, and the insertion of the superior rectus was therefore explored. In both patients this muscle was found to be detached from its normal insertion, and was identified in a retracted position overlying the insertion of the superior oblique. Following surgical re-attachment of the superior rectus, ocular elevation was restored, with resolution of symptoms.