Insertion slanting strabismus surgical procedures.

Insertion slanting recessions or biased resections have been reported to be useful for treating A- and V-pattern strabismus, convergence insufficiency, and convergence excess esotropia. Paradoxically, good results have been reported with methods that are opposite in nature. For example, some researchers would recess the medial rectus muscles and slant the superior pole of each muscle back farther than the inferior pole (Simonsz/von Graefe method) for a V-pattern esotropia, and others would slant the inferior poles back farther (Bietti method). The Simonsz/von Graefe method seems to be based on sound concepts of oculomotor mechanics. The Bietti method has been justified based on a misquoting and misinterpretation of previous work by Alan Scott, MD. Probably neither method contributes substantially to the outcome of strabismus surgery because sarcomere remodeling should rapidly negate the effect of the slanting. Most likely it is the recession or resection itself that affects the outcome.