title: Results of anterior tucking of the superior oblique muscle tendon in bilateral fourth nerve palsy.
abstract: BACKGROUND
  Bilateral fourth nerve palsy is characterised by excyclotorsion, which can be corrected by reinforcement of the anterior tendon fibres of the superior oblique muscle.
  
  
  METHODS
  A retrospective study of 40 consecutive patients with bilateral acquired fourth nerve palsy operated by a selective tuck of the anterior portion of the superior oblique tendon between 1994 and 2012 was undertaken. Horizontal, vertical and torsional deviations were measured in 9 diagnostic positions of gaze and the field of binocular single vision was evaluated with the Harms tangent screen. Postoperative follow-ups took place at 1 week, 6 months, and ≥3 years.
  
  
  RESULTS
  Preoperative mean excyclotorsion was 9° in the primary position and 15° in downgaze. These values decreased to 2° and 5° 6 months after surgery, and 2.5° and 6° at ≥3 years. Immediate post-operative incyclotorsion in upgaze (28 patients) and Brown syndrome (15 patients) regressed spontaneously. The median score of field of binocular single vision improved from 4% preoperatively to 76% postoperatively.
  
  
  CONCLUSIONS
  The selective tuck of the anterior tendon fibers of the superior oblique tendon enables an efficient and long-lasting correction of the ocular torsion induced by bilateral trochlear palsy.
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland (Chairman Prof. Dr Med F. Behar-Cohen).
authors.forename: N
authors.initials: N
authors.lastname: Hoeckele
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland (Chairman Prof. Dr Med F. Behar-Cohen).
authors.forename: P-F
authors.initials: PF
authors.lastname: Kaeser
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland (Chairman Prof. Dr Med F. Behar-Cohen).
authors.forename: G
authors.initials: G
authors.lastname: Klainguti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D058971:Tenotomy / Q000379:methods*; D016896:Treatment Outcome; D020432:Trochlear Nerve Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult