This is my standard technique for recession of a right inferior oblique muscle. I detach the muscle along its length under direct vision, then reattach the anterior fibres 2mm infertemporal to the lateral border of the inferior rectus.
There are many different ways to weaken the inferior oblique muscle, including extirpation, resection, and recession. None of them has any superiority but this technique works best in my hands, and gives me the option of manipulating the posterior fibres in case of extreme upshoot of the eye.
This video demonstrates well the importance of ensuring that the whole of the inferior oblique muscle has been engaged with the squint hook: at first there is a "pink" base to the triangle of muscle representing the separate posterior fibres. When the squint hook is passed again, this time picking up the posterior fibres, there is a "white" base to the triangle. Failure to recognize this will result in a failure to recess the posterior fibres and a subsequent failure to treat the hypertropia.
