The nasal approach to weakening the superior oblique frequently presents a problem in easily securing the tendon. As indicated in several reports, the tendon is either mistakenly not cut, or it cannot be found at surgery. We suggest that a dissection temporal to the superior rectus and passing the hook at the insertion of the superior oblique provides a much more predictable approach with similar effect on A-pattern strabismus. As with any procedure, long-term evaluation is necessary to elicit possible complication.
Goldstein JH. Temporal Approach to Superior Oblique Surgery. Arch Ophthalmol. 1974;92(3):224-226. doi:10.1001/archopht.1974.01010010232011