Comparison of two surgical procedure options for unilateral superior oblique palsy
Reviewed by Fiona Rowe

This study compares two surgical options for management of unilateral superior oblique palsy with angles >20PD. Group 1 underwent one vertical muscle surgery – ipsilateral inferior oblique anterior transposition plus resection (IOATR). Group 2 underwent two vertical muscles surgery – ipsilateral IOAT with contralateral inferior rectus recession. The study included 56 patients: 28 male, 27 female, mean age at surgery of 16.09 ±11.67 years. Group 1 included 33 patients; and group 2, 23 patients with no significant differences in groups at baseline. Group 1 achieved an average 21.6 ±4.3PD hyper correction in primary gaze – 21 ortho, six residual hyper ≤5PD and six >5PD. Group 2 achieved an average 28.26 ±7.61PD correction in primary gaze – 10 ortho and six hyper ≤5PD. Group 1 had a significantly greater improvement in vertical deviation and lower rates of under correction at 8.69% vs 18.18%. In group 1, none had over correction or anti-elevation syndrome whilst group 2 had 21.73% and 4.34% respectively. The authors conclude that both surgery options showed similar success rates. Whilst two muscle surgery had higher correction of hypertropia, this carries a higher risk of over correction and resultant need for reoperation.

One- vs two- vertical muscle surgery in the management of unilateral superior oblique muscle palsy with hypertropia over 20PD.
Farvardin H, Ebrahimi F, Farvardin H, Farvardin M.
STRABISMUS
2025;33(1):13–9.