ABSTRACT
Restrictive strabismus secondary to thyroid-associated ophthalmopathy is commonly managed by recession of the muscles most affected by fibrosis and contracture. The inferior rectus muscle is the most frequently affected extraocular muscle and in asymmetrically affected cases a large vertical deviation can result (Flanders & Hastings 1997). Although unilateral inferior rectus recession using adjustable sutures has been advocated in vertical strabismus, a tendency to overcorrection in downgaze has been reported (Lueder et al. 1992); in another series 9 out of 14 patients undergoing unilateral adjustable surgery suffered a progressive overcorrection in the primary position (Sprunger & Helveston 1993). Other authors have suggested performing inferior rectus recession combined with contralateral superior rectus recession to avoid these consequences (Weir & Ansons 2004). The four consultant strabismologists at our institution utilise the latter procedure with adjustable sutures in large-angle vertical strabismus, performing bilateral inferior rectus recession in more symmetrically affected cases, or unilateral inferior rectus recession in vertical strabismus of a smaller magnitude. We reviewed the results of inferior rectus recession combined with contralateral superior rectus recession.
2 METHODS
