Treatment of incomitant hypertropia and diplopia with recession of the inferior rectus and superior rectus muscles of the same eye

PurposeTo evaluate the effectiveness of recession of the inferior rectus (IR) and superior rectus (SR) muscles of the same eye in the treatment of incomitant hypertropia with diplopia.MethodsRetrospective record review of two groups. (1) Patients with hypertropia and diplopia in downgaze and with fusion in the primary position underwent adjustable recessions of the IR and SR muscles of the eye that was hypotropic in downgaze. (2) Patients with hypertropia and diplopia in the primary position and less hypertropia in downgaze underwent an IR muscle recession of the hypotropic eye in the primary position and adjustable recessions of the contralateral IR and SR muscles.ResultsGroup 1 included four patients. Mean incomitance between primary position and downgaze was 10Δ. After mean follow-up of 44 months, all patients were fusing in the primary position and downgaze. Group 2 included six patients. Mean incomitance between primary position and downgaze was 9.3Δ. After mean follow-up of 40 months, all patients were fusing in the primary position and downgaze. One patient in group 2 required a second procedure.ConclusionsRecession of both vertical rectus muscles of the same eye appears to be an effective, stable, and predictable procedure for patients with incomitant hypertropia with diplopia in downgaze. A modification of this procedure may also be effective for cases in which postoperative hypertropia in downgaze is anticipated with recession of one IR muscle. The procedure is especially appropriate in the treatment of thyroid eye disease, since it is adjustable, and since it does not require resection or posterior fixation of a vertical rectus muscle.