Veenu Maan1, Pradeep Agarwal1, Mohd Masjood1. 1. Department of Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology, C. L. Gupta Eye Institute, Moradabad, Uttar Pradesh, India.
Dear Sir,With great interest, we read the article entitled “Surgical treatment of superior oblique palsy: Predictors of outcome” by Sanz et al.[1] and we thank them for this study.However, we have few observations over which we request the author's comments:First, amblyopia was found to be a risk factor for reoperation.[1] However, the vertical deviation was not mentioned separately for amblyopic and nonamblyopic patients. It may be possible that amblyopic patients have more vertical deviation thus, requiring more than one surgical procedure and it may act as a confounding factor for reoperation. The details about pre- and post-operative visual acuity in amblyopic patient have not been provided. It would add to the predictors of outcome being evaluated in the present study because Frattolillo et al.[2] found improvement in visual acuity after the correction of cyclodeviation in superior oblique palsy and hypothesized the presence of pseudoamblyopia.Second, the author has stated that “Our criteria for surgical treatment of intravenous (IV) nerve palsy included individualization of each case according to the cover test in the 11 positions of gaze, the position of maximum diplopia, and the results of the Lancaster test.” The author wants to emphasize over fourth nerve palsy which has been misprinted as IV nerve palsy. Hence, we would like to request the author to clarify about this.Last, we would also like to draw author's attention to the details provided in Table 1 describing motor and sensory examination, as a total of 76 patients were enrolled in the study, but data of 75 patients are given for initial inferior oblique overaction and data of 74 patients are given for superior oblique underaction.