treatment of a and v pattern strabismus by slanting muscle insertions in farabi eye hospital

purpose : to evaluate outcome of surgically slanting extraocular muscle insertions in a and v-pattern strabismus methods : in this prospective non-randomized interventional case series, we created a slanting surgical reinsertion line with a 3- 4 mm difference between upper and lower corners of the muscles in 16 patients with a or v strabismus (v-exotropia in 10 patients, a-exotropia in 1 patient, v-esotropia in 5 patients). cases with moderate or marked overaction of oblique muscle were excluded. all patients were followed for 6 months. results : v-exotropia: the average amount of v-pattern was 29.5 ∆ before and 9.2 ∆ after surgery. slanting surgery reduced the v-pattern in 10 of 10 patients. the mean amount of reduction was 20.3 ∆ (p<0.0001). all anatomical muscle insertions were normal. v-esotropia: the average amount of the v-pattern was 22.4 ∆ before and 13.2 ∆ after surgery. slanting surgery reduced v-pattern in 4 of 5 patients. the mean reduction was 9.2 ∆ in the v-pattern (p<0.067) and 28 ∆ in down gaze (p<0.003) and 22 ∆ in primary position (p<0.014). a-exotropia: (1 patient) a-pattern was 20 ∆ before and 6 ∆ after surgery. amount of pattern reduction was 14 ∆. conclusion : slanting muscle insertion for correction of a and v strabismus is suitable procedure for reducing a and v-patterns.   iranian journal of ophthalmology 200921(1):41-46 © 2009 by the iranian society of ophthalmology