title: Superior oblique tuck: its success as a single muscle treatment for selected cases of superior oblique palsy.
abstract: OBJECTIVE
  To investigate the results of superior oblique tuck (SOT) for selected cases of superior oblique palsy (SOP) over a 17-year period. The results were correlated by correction of deviation; re-operation rates; rates of iatrogenic Brown's syndrome; and finally, correlation between tuck size and deviation change. Any differences between the results for congenital and acquired SOP are reported.
  
  
  METHODS
  A retrospective, cohort study of adults with SOP-with diplopia greatest in the area of action of the paretic superior oblique-who underwent SOT between 1992 and 2009. Pre-, intra- and postoperative measurements were collected. Vertical and torsional measurements in both primary position and area of maximal deviation were analyzed. Intraoperative tuck size was measured and correlated to effect.
  
  
  RESULTS
  We report 75 cases of isolated SOT with a mean follow-up of 8.6 months. Significant improvement in deviation in all positions measured was shown (P<0.0001 for all). Twenty-two (29.3%) cases underwent further procedures due to residual diplopia. There were no intraoperative complications. Brown's syndrome was demonstrated using a Lees screen in 10 cases but none of these were symptomatic. No patients required tuck revision. There was no correlation between tuck size and changes in either vertical or torsional deviations. 42 (56%) had acquired SOP with no significant differences in pre- or postoperative measurements to congenital cases.
  
  
  CONCLUSIONS
  This is the largest series of SOTs reported with 71% of cases having successful outcome with the one surgical procedure. There are significant improvements in the postoperative measurements for both vertical deviation and torsion. 29.3% of cases required a further procedure consisting mainly of contralateral inferior rectus weakening although ipsilateral inferior oblique weakening was also performed. Because of the lack of correlation between tuck size and correction obtained, we would suggest that SOT should be considered as "one tightness fits all" rather than "one size fits all."
authors: St Paul's Eye Unit, Royal Liverpool University Hospital, UK. jondurnian@me.com
authors: J M
authors: JM
authors: Durnian
authors: I B
authors: IB
authors: Marsh
mesh_terms: D004172:Diplopia / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000209:etiology; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013285:Strabismus / Q000601:surgery*; D016896:Treatment Outcome; D020432:Trochlear Nerve Diseases / Q000601:surgery*