Assessment of Objective Cyclotorsion Changes Following Symmetric and Asymmetric Graded Recession of Inferior Oblique Muscle for V-Pattern Strabismus

Agata Joanna Ordon,1,2 Justyna Simiera,2 Agnieszka Rosa,3,4 Piotr Loba2 1SPKSO Ophthalmic University Hospital, Warsaw, Poland; 2Department of Binocular Vision Pathophysiology and Strabismus, Medical University of Lodz, University Barlicki Hospital No.1, Lodz, Poland; 3Department of Pediatric Neurology, Pediatrics and Rare Disorders, Medical University of Warsaw, Warsaw, Poland; 4Center of Excellence for Rare and Undiagnosed Disorders, Medical University of Warsaw, Warsaw, PolandCorrespondence: Agata Joanna Ordon, Department of Binocular Vision Pathophysiology and Strabismus, Medical University of Lodz, University Barlicki Hospital No. 1, Lodz, Poland, Email [email protected]: This study aimed to evaluate cyclotorsion changes after graded IO recession and compare effects of symmetric vs asymmetric surgeries on torsional asymmetry.Patients and Methods: A retrospective analysis was conducted on 50 patients (100 eyes, mean age 10.5 years) with V-pattern strabismus who underwent graded IO recession. Cyclotorsion was measured using fundus photos and Cyclocheck software before and three months after the surgery.Results: Mean V-pattern deviation decreased significantly (18.62Δ to 2.26Δ, p< 0.001). Cyclotorsion improved from 13.48° to 5.99° in right eyes and 11.50° to 8.39° in left eyes, averaging a 2.52° reduction per 2 mm of recession. A moderate positive correlation was found between total IO recession and torsion change (r=0.46). Preoperative cyclotorsion asymmetry between eyes also decreased significantly, regardless of surgical symmetry.Conclusion: Graded IO recession effectively reduces V-pattern deviation and excyclotorsion. It also improves interocular torsion symmetry, whether performed symmetrically or asymmetrically.Keywords: V-pattern strabismus, objective cyclotorsion, inferior oblique overaction, inferior oblique recession, disc-foveal angle, Cyclocheck