Bilateral recession of superior rectus muscles: Its influence on A and V pattern strabismus

PURPOSE: To determine whether bilateral superior rectus recession modifies A and V pattern strabismus. PATIENTS AND METHODS: Three patients with V patterns and eight patients with A patterns underwent bilateral superior rectus recession with neither oblique muscle surgery nor vertical displacement of the horizontal rectus muscles. Another three patients with A patterns underwent simultaneous superior oblique tenotomy and superior oblique recession. RESULTS: Two of the patients with V patterns demonstrated an increase in the V pattern after surgery; one was unchanged. Five of the patients with A patterns converted to V patterns after surgery. In the remaining three patients the pattern was eliminated. The three patients who underwent superior oblique tenotomy along with superior rectus recession had large shifts toward V pattern (mean shift, 40 delta). CONCLUSION: Bilateral superior rectus recession tends to increase V patterns and reduce A patterns. Superior rectus recession may be synergistic with superior oblique tenotomy in collapsing an A pattern.