title: Postoperative adjustable surgery of the superior oblique tendon.
abstract: OBJECTIVE
  To describe a surgical procedure for loosening or tightening the superior oblique (SO) tendon that enables bedside adjustment following the surgery, with surgical outcome reported.
  
  
  METHODS
  A permanent suture separates the two cut ends of the SO tendon, with a sliding noose for adjustment. The noose is accessed by having the patient look up or straight ahead, not down, during adjustment at the bedside. Records of 17 patients who underwent this surgery between June 2000 and January 2003 were reviewed and analyzed for outcome.
  
  
  RESULTS
  Seventeen patients, 18 eyes, mean age 43.7 years (range 5.9 to 71 years) had SO surgery with postoperatively adjustable sutures. Twelve eyes of 11 patients had a loosening procedure, and six eyes had a tightening procedure. Seven of the patients had had precious eye muscle surgery, four having had previous surgery on the same SO tendon. All but one patient returned for the follow-up examination, ranging from 1.5 to 7 months postoperatively. Torsional imbalances in 12 patients improved in all but two. In four patients with a preoperative A pattern, the A pattern improved from 16 PD to 0 PD on average. In eight patients with vertical misalignment in straight ahead gaze who had no other cyclovertical muscle surgery simultaneously, the mean reduction was 7 PD. All patients except one had improvement in preoperative symptoms.
  
  
  CONCLUSIONS
  Both loosening and tightening procedures can be performed successfully using a postoperative adjustment technique for the SO tendon.
authors.affiliation: The Zanvyl Krieger Children's Eye Center at The Wilmer Institute The Johns Hopkins University School of Medicine, Baltimore, MD 21287-9028, USA.
authors.forename: Nitza
authors.initials: N
authors.lastname: Goldenberg-Cohen
authors.forename: Kristina
authors.initials: K
authors.lastname: Tarczy-Hornoch
authors.forename: David F
authors.initials: DF
authors.lastname: Klink
authors.forename: David L
authors.initials: DL
authors.lastname: Guyton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods; D011184:Postoperative Period; D012189:Retrospective Studies; D013285:Strabismus / Q000601:surgery*; D013536:Suture Techniques; D013710:Tendons / Q000601:surgery*; D016896:Treatment Outcome