Procedure shows benefit for managing class 3 tendon anomaly in superior oblique palsy

Repositioning and strengthening the superior oblique tendon in the Tenon capsule can significantly improve eye alignment and binocularity among patients with superior oblique palsy who are diagnosed with a class 3 tendon anomaly, a study found.

Miho Sato MD, PhD, and colleagues evaluated surgical outcomes, preoperative eye alignment, visual acuity and stereopsis measurements for 141 patients who underwent surgery for congenital and idiopathic superior oblique palsy between September 1995 and August 2007. Intraoperatively, the surgeons explored the superior oblique tendons in 26 of these patients and diagnosed class 3 tendon anomalies in five patients.

"Without careful search of the Tenon capsule, the condition can be misdiagnosed as an absent tendon," the study authors said in the September issue of American Journal of Ophthalmology.

The five patients with class 3 superior oblique tendon anomalies underwent a total of eight procedures, with each patient receiving surgery on three muscles, the authors noted.

While vertical deviation was largest in patients with class 4 tendon anomaly, the investigators found no significant difference between the amount of vertical deviation in patients with class 3 tendon anomaly and patients with other types of tendon anomalies.

While stereoacuity measurements were significantly better among patients with class 3 anomaly than among patients with class 4 anomaly (P < .05), there were no significant differences between stereoacuity measurements among patients with class 3 anomalies and patients with class 1 or class 2 anomalies, according to the study.