After playing the game for almost a year, I think it's time to make a final judgement about the game.
Since modern game reviews tend to to seperate a game into different categories, I'll do that as well.
Graphics[]
If you want high end graphics, this is certainly not the kind of game you are looking for. That's the main complaint. Minor problems are a whole slew of graphical bugs and the reuse of many sprites in Wrath of the Lamb.
On the positive side you get a very unique style. The whole game has this "drawn by Isaac himself with his crayons", which in combination with the grim depicted topics creates something truly weird. Weird in a good way.
I mentioned the recycling of sprites before. Don't be fooled by that statement, since the game contains a huge amount of sprites. Each item has a unique look (except for the health items, but that is nit-picking) for example.
Sound[]
Danny B. made the music for the game. And he did a very good job at it. The music sounds haunting and eerie and still manages to be catchy. I still love to listen to it up to today.
Sound effects however cannot catch up to the great soundtrack. In general the effects do their job, but are a bit repetetive.
Options and Controls[]
The game doesn't offer many options and the menu still doesn't work as fully intended (clicking the mute button for example can do nothing at all sometimes). Also the game does not support a controler.
Talking about control, the game plays very well with a keyboard. Movements are fluent and the controls quickly respond. The control scheme did never hinder me from playing the game.
Personal Opinion: I think people who continuosly keep complaining about the unofficial-only suport for (xbox-)controlers are a bunch of spoiled brats. Your Xbox is not the pinnacle of everything.
Performance and Support[]
The game is coded in Action Scipt 2 (Flash) and therefor inherits all of its problems. This includes problems with displaying multiple moving objects and difficulties with handling lager amounts of content. Playing the game smoothly on higher resolutins is neight impossible. Also the game has lots of bugs, but thankfully most of them are random corner cases or can even be mistaken as intented.
As for the support: The game is a great example for the reliability of indie game developers. The game was patched numerous times, each time helping the game to stabilize further. Great amounts of free game content that was added in some of these patches should also be mentioned.
Gameplay[]
The game is hard and unforgiving. The urge to deinstall it after the first few triesis understandable. But nobody does that. You will keep playing and you will get better. After your first Mom-Kill the game throws a huge amount of unlockables at you and keeps you playing.
Hell, you even might end up as an admin for a wiki deticated to that game!
That is the magic of the Biniding of Isaac:
You will hate it, you will curse it, but it keeps you playing and it is satisfying. The game reminds me of the old days of gaming where you actually had to learn to beat a game. Random generation will cause every run the be different, adding to playability.
But then came WotL and it's new slew of content. The new monsters, bosses and levels were designed around the new powerfull items. In the end patching the game gave all items the same chance to appear.
So now you have to fight through a game that has it's entirely structure focused around more challenging concepts. This means that you either get certain items the make your run a breeze or you can try to struggle till the cathedral the get curb-stomped.
Making a final boss into an item check is just silly. Not giving you the chance to fight your way through with skill is even more.
Verdict[]
The game is incredible cheap for the amount of playtime you can sink into it. Go and try it out, but try to play the pre-WotL for some time before you decide to install the DLC. Otherwise you might loose interest quickly.