PURPOSE To evaluate and compare different surgical approaches for the treatment of Helveston syndrome and provide further information for preoperative planning. METHODS From February 2008 to December 2018, data of 52 patients with Helveston syndrome were retrospectively reviewed. Different surgical approaches were selected based on the extent of A-pattern exotropia, dissociated vertical deviation (DVD), and both superior oblique muscle overaction (SOOA) with fundus photograph intorsion. Eye position, A-pattern, DVD, superior oblique muscle function, and binocular vision function were evaluated pre- and postoperatively. The average follow-up duration was 20.5 months. RESULTS Nine cases underwent simultaneous horizontal deviation correction with bilateral superior rectus recession, 24 underwent simultaneous horizontal deviation correction with bilateral superior oblique muscle lengthening, and 19 underwent two stages of horizontal deviation correction with superior oblique muscle lengthening, and later bilateral superior rectus recession. A-pattern, DVD, SOOA, and fundus intorsion were all collapsed in all patients postoperatively. Forty-five patients had an orthophoric eye position with considerably aligned ocular movements postoperatively. The total success rate was 86.5%. Postoperatively, eight of the 10 patients with diplopia experienced a recovery of binocular single vision and three had a recovery of rudimentary stereopsis (Titmus 3000-400 s of arc). The compensatory head posture of patients improved significantly postoperatively. CONCLUSIONS The surgical planning of Helveston syndrome should be designed based on the degree of the A-pattern, SOOA, DVD, and the intorsion in fundus photographs, and the appropriate approach should be selected to improve patient satisfaction.

中文翻译：

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Helveston 综合征（三联症外斜视）的手术治疗。

目的 评估和比较治疗 Helveston 综合征的不同手术方法，并为术前计划提供更多信息。方法回顾性分析2008年2月至2018年12月52例Helveston综合征患者资料。根据 A 型外斜视的程度、分离性垂直偏差 (DVD) 和上斜肌过度作用 (SOOA) 与眼底照片内翻，选择不同的手术方法。术前和术后评估眼位、A型、DVD、上斜肌功能和双眼视觉功能。平均随访时间为20.5个月。结果 9例双侧上直肌后退同时进行水平偏差矫正，24人同时进行了双侧上斜肌延长的水平偏差矫正，19人接受了双侧上斜肌延长和双侧上直肌后退两个阶段的水平偏差矫正。所有患者术后均塌陷A型、DVD、SOOA和眼底内翻。45 名患者术后采用正射眼位，眼球运动相当一致。总成功率为86.5%。术后，10 名复视患者中有 8 名双目单视恢复，3 名基本立体视恢复（Titmus 3000-400 s 弧度）。术后患者的代偿性头部姿势明显改善。