Adding a Short-Tag Adjustable Inferior Rectus Recession

In patients with IV nerve palsy and significant inferior oblique (IO) overaction, a weakening procedure of the ipsilateral IO is often indicated. When the vertical deviation in primary position (PP) exceeds 15 PD, a single muscle procedure of IO transposition might not be sufficient and a recession of the contralateral inferior rectus (IRc) on adjustable sutures might be added. Late overcorrection of adjustable sutures in IRc can be avoided if a combination of nonabsorbable and absorbable sutures is used for the adjustable knots.