[Advancement of the anterior portion of the superior oblique tendon in case of traumatic bilateral trochlear palsy].

The effect of the advancement of the anterior portion of the superior oblique tendon on cyclovertical and horizontal deviation was studied in seven cases of traumatic bilateral trochlear palsy by using a synoptometer (Cüppers) and cyclodevinometer (Kolling). The anterior portion of the superior oblique tendon was disinserted and advanced laterally according to the amount of the cyclodeviation in primary position with 1 degree/mm. Surgery was done in 5 cases on both eyes, in 2 cases on one eye. The age of the patients ranged from 20 to 64 years (mean 45 years). The excyclodeviation was significantly reduced (p less than .01), however overcorrection was found in the upward gaze. The mean reduction of excyclodeviation in diagnostic positions of gaze was approximately 10-12 degrees. The vertical deviation was significantly reduced in up and downward gaze (p less than .05), nevertheless overcorrection was found in the upward gaze. The mean reduction of the vertical deviation differed according to their positions of gaze. V-pattern esotropia could not be reduced significantly. Therefore an alternative operative approach must be found which can avoid overcorrection in the upward gaze and moreover correct V-pattern esotropia in the downward gaze.