Simultaneous 4-muscle surgery in V-esotropia.
Simultaneous, bilateral and symmetrical surgery was performed on 60 patients with V-esotropia. The results following one surgical procedure were evaluated. The patients were subdivided into three equal groups. A bilateral recession of the medial recti was performed in all three groups. In the first two groups a weakening of both inferior obliques, either by recession or by myectomy at insertion, was performed. In the third group only horizontal muscle surgery was done. Satisfactory results were achieved in 48 out of 60 patients following one surgical procedure. Consecutive esotropia was present in eight and exotropia in four patients. In cases of V-esotropia with marked overaction of both inferior obliques, a simultaneous 4-muscle surgery is recommended in order to minimize the number of surgical procedures.