An enduring classic revisited: a comparative study of standard vs. augmented FINK techniques in V-pattern correction

Purpose: To compare the efficacy of the original and augmented Fink techniques in the surgical correction of V-pattern strabismus associated with primary inferior oblique overaction. Methods: We conducted a retrospective chart review of patients who underwent concurrent horizontal strabismus surgery (recess - resect procedure) and bilateral symmetric inferior oblique recession using either the standard Fink technique (corresponding to an 8-mm recession) or augmented variants (9, 10, or 11-mm recession). The primary outcome assessed was reduction in V-pattern strabismus, measured in prism diopters (PD) using prism and alternate cover testing in primary position,upgaze, and downgaze. Results:  Twenty-nine patients were studied. Ten underwent the standard Fink procedure with bilateral 8-mm recessions. The remaining patients received augmented recessions: 8 patients with 1 mm (9 mm total), 2 patients with 2 mm (10 mm total), and 9 patients with 3 mm (11 mm total) beyond Fink's original point. Greater inferior oblique recession correlated with larger postoperative reduction of V-pattern strabismus. The 11-mm group achieved the greatest correction, significantly more than the 8-mm (p = .002) and 9-mm groups (p = .018). The 9-mm group showed more variability in outcomes, while the 10-mm group had intermediate corrections but limited by a small sample size (n = 2). Conclusions: Augmenting the Fink technique by placing the inferior oblique insertion more inferiorly enhances correction of V-pattern strabismus, especially with 11-mm recessions, without causing significant anteriorization. These findings indicate that progressive augmentations can be customized based on the severity of the V-pattern. Larger, prospective studies are needed to validate these findings and refine surgical protocols.