Suspension recession of inferior oblique versus graded recession technique in V-pattern strabismus with primary inferior oblique overaction

Purpose The aim of this study was to evaluate the efficacy of inferior oblique suspension recession ‘modified hang-back’ in cases with V-pattern strabismus and primary inferior oblique overaction (IOOA), compared with standard graded recession technique. Patients and methods Thirty patients (60 eyes) presenting with V-pattern strabismus with primary IOOA were enrolled and randomized for inferior oblique weakening intervention − that is, suspension recession (group A), or standard graded recession (group B). Results In group A, the mean postoperative V-pattern exotropia was 4.8±2.7 PD as compared with a mean of 26.42±6.26 PD preoperatively (P≤0.001). Meanwhile, for the esotropic subgroup, the values were 2.57±1.13 and 15.62±4.17 PD, respectively (P≤0.001). For group B patients, the mean V-pattern exotropia was 2±1.5 PD, compared with a preoperative mean value of 23.12±10.66 PD (P≤0.001), and the mean pattern esotropia was 2.28±1.79 PD, compared with a preoperative mean value of 17.14±3.93 PD (P≤0.001), with a highly significant statistical difference between patients within the same group (P≤0.001), as well as between the two groups as regards the exotropic subgroups (P≤0.02). A significant improvement in IOOA was noted in group B, whereas the postoperative hypertropia in lateral gaze was 0.97±1 PD, compared with 5.06±2 in group A (P≤0.001). Conclusion Although considerable results were achieved with the suspension recession technique, the postoperative impact of the procedure as regards the control of IOOA may be still questionable, with significant superior results of the standard recession technique.