Inferior rectus recession for vertical tropia after cataract surgery

Four patients with de novo onset of persistent vertical tropia ranging from 4 to 11 prism diopters (PD) after cataract surgery underwent inferior rectus recession. Deviations were stable and fuseable with prism preoperatively for 4 to 6 months. Three patients regained single binocular vision in all fields of gaze. Macular change developed in one eye of a diabetic patient, precluding adequate postoperative assessment. Mechanical and sensory factors, detailed assessment of pertinent preoperative findings, and intraoperative management are discussed. Previous literature is reviewed.