Treatment of superior oblique palsy with superior oblique tendon tuck and inferior oblique muscle myectomy.

Twelve patients underwent quantitated superior oblique tendon tuck and ipsilateral inferior oblique muscle myectomy in the primary treatment of unilateral superior oblique muscle palsy. Preoperatively, each patient exhibited a vertical deviation of 30-55 prism diopters in at least one position of gaze. Following a single operation, satisfactory ocular alignment was obtained in all but one case, with fusion demonstrable in clinically significant gaze positions. Eight of 12 patients had no measurable vertical deviation in primary position, and two others had residual hyperphorias of only two prism diopters. No tucks were removed for postoperative Brown's syndrome. Superior oblique tendon tuck combined with ipsilateral inferior oblique muscle myectomy appears to be a safe and effective treatment for large angle superior oblique muscle palsy.