title: Contralateral superior oblique posterior tenotomy (SOPT): a primary treatment for diplopia in downgaze following blowout orbital fracture.
abstract: OBJECTIVE
  Superior oblique posterior tenotomy (SOPT) is a recognized surgical treatment to weaken the depressor effect of the superior oblique muscle without causing excyclotropia. We analyzed its use in the management of diplopia in downgaze due to contralateral blowout orbital fracture.
  
  
  METHODS
  We performed a retrospective case note review of patients that had undergone an SOPT as a primary surgical option in the management of diplopia in down gaze caused by contralateral blowout orbital fracture. The study covered a 17-year period from 1993 and 2010. These cases had diplopia maximal to the side of the orbital blowout. Pre- and postoperative orthoptic measurements were compared. Surgical complications were noted.
  
  
  RESULTS
  Five patients who fulfilled the entry criteria were identified. The mean follow-up period was 15.2 months (range 6-20 months). Preoperatively, the median |dev| was 2 prism diopters (PD) in primary position (range, 0-2) and 8 PD in downgaze (range, 2-18). At the final follow-up, the median |dev| in primary position was 0 PD (range, 0-2) and 2 PD in downgaze (range, 0-12). There were no significant differences pre- and postoperatively in both the primary position (p=0.19) or in downgaze (p=0.25) despite the large reduction in deviation size. Two patients needed a second procedure following SOPT. No patients complained of torsion, not in the primary position or in downgaze following the surgery.
  
  
  CONCLUSIONS
  Contralateral SOPT can be a useful and simple primary treatment option for patients with moderate vertical deviations in downgaze to the same side of the orbital fracture. Larger deviations may require second surgeries. SOPT does not cause iatrogenic excyclotorsion and avoids surgery to a potentially much scarred inferior rectus area.
authors.affiliation: Department of Ophthalmology, University Hospital, Aintree, Livepool, UK. Adesuwa.garrick@nhs.net
authors.forename: Adesuwa
authors.initials: A
authors.lastname: Garrick
authors.forename: Jonathan
authors.initials: J
authors.lastname: Durnian
authors.forename: Gareth
authors.initials: G
authors.lastname: Hewitt
authors.forename: Ian
authors.initials: I
authors.lastname: Marsh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004172:Diplopia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005133:Eye Movements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D009917:Orbital Fractures / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies; D013524:Surgical Flaps; D058971:Tenotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology*; D055815:Young Adult