الفهرس 
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Abstract
Purpose: to evaluate the treatment algorithm for the surgical management of superior oblique palsy according to different presentations.Materials and methods : Retrospective & prospective maintained database study comprised 280 patients diagnosed as superior oblique palsy. Complaint was assessed preoperatively & postoperatively e.g., Abnormal head posture (AHP), diplopia & cosmetically unaccepted vertical deviation. Vertical deviation (VD) in primary position was measured by alternate prism-cover test preoperatively, at 1 week, 3 months and 6 months postoperatively. Inferior oblique overaction was assessed preoperatively & postoperatively. All patients underwent single muscle surgery as a primary surgery for treatment of SOP. Successful outcome was defined as hypertropia of 5 prism diopters (PD) or less in primary position. Results: The whole study enrolled 280 patients who diagnosed as congenital or acquired superior oblique palsy and underwent single muscle surgery as a primary surgery. The patients were divided according to the degree of hypertropia (HT) in primary position into 3 groups, group I: included 186 patients who had less than 15 PD hypertropia and they were subdivided according to the type of primary surgery into: subgroup Ia: 147 patients for whom IO weakening procedures were done and subgroup Ib: 39 patients for whom other than IO weakening procedures were done as primary surgery. group II: included 88 patients who had 15-30 PD hypertropia. group III: include 6 patients who had more than 30 PD hypertropia. The surgical outcome of single muscle surgery for hypertropia less than 15 PD, was good in 91.2% of subgroup Ia even in patients with no or mild IOOA (grade 1) vs. 41% of subgroup Ib with statistically significant difference (P <0.001). It was good in 44.3% of group II vs. 0% of group III with statistically significant difference (P=0.040). Conclusions: • IO weakening should be the primary muscle surgery in the treatment of superior oblique palsy even in patients with no or mild IOOA (grade +1). IO weakening could be effective in primary position hypertropia up to 15-20 PD. Two muscle surgery may be required in large hypertropia (15-30 PD) & even three muscle surgery in larger hypertropia (more than 30 PD).•Type of any surgery other than IO weakening procedures should be based on intraoperative force duction test (FDT) for superior oblique (SO) tendon laxity & superior rectus (SR) contracture.Keywords : Superior oblique palsy, vertical deviation