After the APSPOS conference in Brisbane, I came away surprised at the amount of times the surgeons referred to Superior Oblique recession surgery. It was mentioned for thyroid and for A patterns with SO overaction. I was always under the impression that this was not done since it would interfere with torsion, but it seemed to be dropped into conversation (Jonathan Holmes, Andrea Molinari) as though it was the norm. Brenda Breidenstein (Wellington) commented she had done it a few times – but then I then got sidetracked and I didn’t get the chance to ask her when she had chosen to do this. Derek has not done any – he tends to use up or down displacement of the medial/lateral recti in A patterns and I think Justin tends to use spacers ??

I couldn’t find many up to date articles on superior oblique surgery for A pattern – most were for superior oblique spacers or tenectomies rather than recessions. I did find this article from the Pediatric Ophthalmology education centre which is a good overall recap on A’s and V’s and does mention recession as an option briefly.

It is odd to open – if you click on it and then click on the top sentence “skip to main content” this should bring up the article. Is also on this weblink:

Pattern Strabismus – American Academy of Ophthalmology

My feeling is A patterns with Superior Oblique overactions are hard to get right and often remain with a residual overaction whichever method of surgery is used. I am interested to see if anyone else has any comments/gut feelings or surgeons who routinely would choose to do a recession on this muscle. I have also attached my old teaching notes for A and V which I think are largely still relevant, but maybe need to be updated!

A and V pattern theories: Document

Any comments/thoughts/amendments to my notes gratefully received!