title: Effect of modified graded recession and anteriorization on unilateral superior oblique palsy: a retrospective study.
abstract: BACKGROUND
  Several inferior oblique (IO) weakening methods exist for correction of superior oblique palsy (SOP). A previously reported method involved recession and anteriorization according to IO overaction (IOOA) grade, which might be subjective and cause upgaze limitation and opposite vertical strabismus. Therefore, this study attempted to examine the efficacy of modified graded recession and anteriorization of the IO muscle in correction of unilateral SOP without resulting in upgaze limitation or opposite vertical strabismus.
  
  
  METHODS
  A total of 26 patients (male, 16; female, 10; age: 3-40 years) with SOP and head tilt or diplopia underwent modified graded recession and anteriorization. Patients were grouped by the position at which the IO muscle was attached inferior/temporal to the lateral border of the inferior rectus (IR) as follows: (1) 7.0/2.0 mm (4 patients), (2) 6.0/2.0 mm (3 patients), (3) 5.0/2.0 mm (3 patients), (4) 4.0/2.0 mm (11 patients), (5) 3.0/0.0 mm (2 patients), and (6) 2.0/0.0 mm (3 patients). Recession and anteriorization were matched to vertical deviation in the primary position at far distance. Remaining diplopia, head tilt, vertical deviation (≤3 prism diopter (PD), excellent; 4-7 PD, good; and ≥ 8 PD, poor), upgaze limitation, and opposite vertical strabismus were evaluated.
  
  
  RESULTS
  The average pre and postoperative 1-year vertical deviation angles in the primary position at far distance were 15.0 ± 5.6 PD and 1.2 ± 2.0 PD, respectively. At 1 year post-surgery, the vertical deviation angles were reduced by 6.8-21.0 PD from those at baseline. Few patients exhibited remaining head tilt, diplopia, upgaze limitation, or opposite vertical strabismus. Correction of hypertropia was excellent in 22 and good in 4 patients.
  
  
  CONCLUSIONS
  Modified graded recession and anteriorization of the IO muscle is an effective surgical method for treating unilateral SOP. It exhibits good results and reduces the incidence of opposite vertical strabismus.
authors.affiliation: Department of Ophthalmology, Keimyung University Dongsan Medical Center, Keimyung University school of Medicine, Daegu, 41931, South Korea.
authors.forename: Dong Cheol
authors.initials: DC
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Keimyung University Dongsan Medical Center, Keimyung University school of Medicine, Daegu, 41931, South Korea. lsy3379@dsmc.or.kr.
authors.forename: Se Youp
authors.initials: SY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004172:Diplopia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005133:Eye Movements / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D020432:Trochlear Nerve Diseases / Q000503:physiopathology / Q000601:surgery*; D015348:Vision, Binocular; D055815:Young Adult
keywords: Anteriorization; Inferior oblique muscle; Modified graded recession; Unilateral superior oblique palsy