Treatment for 'A' or 'V' pattern esotropia by slanting muscle insertion

Background-Patients with 'A' or 'V' pattern esotropia without vertical muscle overaction have traditionally been treated with medial rectus recession and vertical transposition of the muscle insertions. Method-Seven cases are presented treated by slanting muscle insertions, whereby the lower margin of the medial rectus is preferentially recessed more than the upper margin in esotropia, and the upper margin is recessed more than the lower margin in A esotropia. Results-All seven patients had their A or V patterns eliminated, with six achieving good alignment in all positions of gaze. Conclusion-The slanting muscle insertion should be considered as an alternative technique in all cases of A or V pattern esotropia.