Isolated Superior Oblique Tucking: An Effective Procedure for Superior Oblique Palsy with Profound Superior Oblique Underaction

Purpose: To compare efficacy and complications of isolated unilateral superior oblique tucking in patients with unilateral superior oblique palsy (SOP). Method: A retrospective analysis of 24 cases of unilateral SOP, 13 Acquired (group 1), and 11 Congenital (group 2), who underwent isolated unilateral superior oblique tuck over a 13-year period was performed. Results: The mean preoperative vertical deviation in primary gaze was 10 ± 3 PD for group 1 and 12 ± 5 PD for group 2 and mean vertical deviation in lateral gaze of affected superior oblique was 19 ± 5 PD for group 1 and 21 ± 9 PD for group 2. The mean postoperative vertical deviation in primary gaze for group 1 after a mean follow-up period of 15 ± 21 months was 1 ± 3 PD; for group 2 after a mean follow-up period of 17 ± 13 months was 2 ± 3 PD, and in lateral gaze of affected superior oblique was 3 ± 5 PD for group 1 and 5 ± 6 PD for group 2. The mean correction of vertical deviation in primary gaze at last follow-up was 8 ± 2 PD for group 1 and 9 ± 5PD for group 2 (P > 0.05) and in the lateral gaze field of affected superior oblique muscle was 16 ± 4 PD for group 1 and 15 ± 5 PD for group 2 (P > 0.05). The mean preoperative torsion was 9 ± 4 degrees for group 1 and 9 ± 2 degrees for group 2; mean postoperative torsion was 1.2 ± 2.2 degrees for group 1 and 1 ± 1 degrees for group 2. The mean torsion corrected for group 1 was 8 ± 3 degrees and for group 2 was 8 ± 2 degrees (P > 0.05). Only one patient in group 1 and three patients in group 2 required reoperation to correct residual deviation. A mild postoperative limitation to elevation in adduction was seen in all cases but was asymptomatic and lessened over time. Conclusion: Isolated unilateral superior oblique tucking corrected a large amount of the vertical deviation and torsion with minimal complications in selective patients of both congenital and acquired superior oblique palsy. Superior oblique tucking is a safe and effective procedure and can be considered in patients with SOP meeting selective criteria.