Dr Conrad Berens, New York, NY: In transplanting the superior oblique for complete third nerve paralysis, it is well to keep in mind the important structures around the trochlear pulley. I had success with the first 3 operations in opening the pulley with a canaliculus knife, as suggested by Peter, but my last 2 (unhappy) experiences made me certain that in freeing the tendon, one should approach the pulley from a cutaneous incision. Reference: Fink WH. Surgical anatomy of the superior oblique muscle. Arch Ophthalmol. 1950;43:943.
A look at the past . . .. Arch Ophthalmol. 2000;118(3):336. doi:10.1001/archopht.118.3.336