Session: Free papers Session VI - Vertical Strabismus
Combined superior oblique and superior rectus surgery for unilateral superior oblique palsy
Introduction: In case of unilateral superior oblique (SO) palsy with hypertropia in primary position (PP) exceeding 15-20D, a surgical procedure on 2 muscles is often recommended. A procedure consisting in a unilateral combination of a SO tendon tuck and a superior rectus (SR) recession is a surgical option recommended by some authors but the reports about this procedure are rare. The purpose of this study is to describe a series of patients with unilateral SO palsy treated by a combined procedure of SO tucking and SR recession.
Methods: We retrospectively the files of patients with a SO palsy who underwent a combined procedure of SO tucking and SR recession as a first surgery between 2013 and 2021 in our institution. The indication was a hypertropia of large angle without major elevation in adduction.
Results: 34 patients (8 female, 24%), mean aged of 36 years (6 to 80) were included. The median preoperative angle of hypertropia in PP was 25D (10 to 35). During surgery, the SR elongation measured using the Rapp-Roth myometer was decreased in all the patients but two, with a mean hypolongation of 3 mm (0 to 7). The surgery consisted in mean SO tuck of 8mm (5 to 12), and a mean SR recession (based on the SR elongation) of 4mm (2 to 6). The median follow-up 13 month (2 months to 10 years). The median postoperative (2 months) angle of hypertropia in PP was 3D (-8 to 20). The surgery induced a median decrease of the objective torsion (measured using retinophotography and Strabocheck® online software) of 2,7° (-4,4 to 11,0) in the operated eye (p<0.001). 6 patients underwent a later surgery (only one for an inversion of the angle).
Conclusions: The combined procedure of SO tucking and SR recession for unilateral is an interesting option for first surgery for large angle SO palsy. It is efficient on the vertical angle, with a low (but non-reproducible) torsional effect.