Treatment of A and V Pattern Strabismus by Slanting Muscle Insertions in Farabi Eye Hospital

To evaluate outcome of surgically slanting extraocular muscle insertions in A and V-pattern strabismus 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. 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 ∆. Slanting muscle insertion for correction of A and V strabismus is suitable procedure for reducing A and V-patterns.