This study aims at evaluating the effectiveness of two of the surgical modalities used in management of A-V pattern strabismus. It included 40 patients; they were divided into 25 patients who had V pattern due to significant inferior oblique overaction and underwent IO recession with horizontal muscle surgeries and 15 patients who had A-V pattern not associated with significant oblique dysfunction and underwent vertical transposition of horizontal recti with recession and/or resection. The follow up period was 6 months. Both procedures appeared to be safe and effective in elimination of the pattern and with stable results throughout the follow up period.