J Korean Ophthalmol Soc.  2008 Dec;49(12):1974-1980.

Clinical Study of A-V Pattern Strabismus in Korea

• Chang WS
• Kim SY

Abstract

PURPOSE: To assess the prevalence of A-V pattern strabismus and evaluate the clinical characteristics, surgical methods and outcomes.
METHODS
Among 825 patients who underwent horizontal strabismus surgery, the records of patients with A-V pattern strabismus were reviewed retrospectively. The prevalence and clinical characteristics of patients with A-V pattern strabismus were assessed and the surgical methods and outcomes of A-V pattern strabismus were evaluated.
RESULTS
Among 825 patients with horizontal strabismus surgery, 113 (13.7%) patients had A-V pattern. V exotropia was the most common (65.5%) and A esotropia was the least common (7.1%) pattern. A +1.9 inferior oblique overaction in 92.8% of the V-pattern patients and a +1.5 superior oblique overaction in 70.0% of the A pattern patients was found. Among the 113 patients, 64.6% patients underwent oblique muscle surgery and 35.4% patients underwent vertical transposition of horizontal muscle. Vertical incomitance was significantly reduced after surgery in all types of A-V pattern strabismus (p<0.05) with a surgical success rate of 96.5%.
CONCLUSIONS
A 13.7% prevalence of A-V pattern in horizontal strabismus patients was found, with V exotropia being the most common. The vertical incomitance was successfully corrected after surgery.

Keyword

A-V pattern; A esotropia; A exotropia; V esotropia; V exotropia

MeSH Terms

Esotropia
Exotropia
Humans
Korea
Muscles
Prevalence
Retrospective Studies
Strabismus

Figure

• 

  Figure 1. Distribution of A-V pattern strabismus among 113 patients; * XT=exotropia; † ET=esotropia.

Reference

References

1. Albert DG. Personal communication In Parks MM Annual review Strabismus. Arch Ophthalmol. 1957; 58:152.

2. Von Noorden GK. Binocular Vision and Ocular Motility. 6th. St. Louis: Mosby;2002. p. 396–413.

3. Breinin GM. The physiopathology of the "A" and "V" patterns. Trans Am Acad Ophthalmol Otolaryngol. 1964; 68:363–74.

4. Knapp P. Vertically incomitant horizontal strabismus: The so-called A and V syndromes. Trans Am Ophthalmol Soc. 1959; 57:666–99.

5. Kim SJ, Bae EH, Oh JS. A clinical study on A and V patterns. J Korean Ophthalmol Soc. 1987; 28:1329–38.

6. Woo KI, Chang BL. Treatment of AV Syndrome. J Korean Ophthalmol Soc. 1993; 34:331–6.

7. Chew E, Remaley NA, Tamboli A. . Risk factors for esotropia and exotropia. Arch Ophthalmol. 1994; 112:1349–55.

8. Rah SH, Jun HS, Kim SH. An epidemiologic survey of strabismus among school-children in Korea. J Korean Ophthalmol Soc. 1997; 38:2195–9.

9. Del Monte MA, Parks MM. Denervation and extirpation of the inferior oblique. An improve weakening procedure for marked overaction. Ophthalmology. 1983; 90:1178–85.

10. Urist MJ. The etiology of the so-called A and V syndromes. Am J Ophthalmol. 1958; 46:835–44.

11. Costenbader FD. Symposium: The A and V pattern in strabismus. Introduction. Trans Am Acad Ophthalmol Otolaryngol. 1964; 68:354–5.

12. Breinin G. Symposium: The A and V pattern in strabismus. The physiopathology of the A and V patterns. Trans Am Acad Ophthalmol Otolaryngol. 1964; 68:363–74.

13. Von Noorden GK, Oslon CL. Diagnosis and surgical management of vertically incomitant horizontal strabismus. Am J Ophthalmol. 1965; 60:434–42.

14. Kushner BJ. The role of ocular torsion on the etiology of A and V patterns. J Pediatr Ophthalmol Strabismus. 1985; 22:171–9.

15. Goldstein JH. Monocular vertical displacement of the horizontal rectus muscles in the A and V patterns. Am J Ophthalmol. 1967; 64:265–7.

16. Chang HR, Kim JM. Effect of vertical displacement of bilateral horizontal muscles in AV syndrome. J Korean Ophthalmol Soc. 2000; 41:506–10.

17. Chang BL, Han YB, Kim SY. Inferior oblique muscle recession. J Korean Ophthalmol Soc. 1982; 23:91–4.

18. Knapp P. A and V patterns. In : symposium on strabismus. Transaction of the New Orleans Academy of Ophthalmology, St. Louis: CV Mosby-Year Book;1971. p. 242–54.

19. Caldeira JA. Bilateral recession of the superior oblique graded according to the A pattern: A prospective study of 21 consecutive patients. Binocul Vis Eye Muscle Surg Q. 1995; 10:167–74.

20. Scott WE, Jampolsky AJ, Redmond MR. Superior oblique tenotomy: indications and complications. Int Ophthalmol Clin. 1976; 16:151–9.

21. Prieto-Diaz J. Management of superior oblique overaction in A-pattern deviations. Graefes Arch Clin Exp Ophthalmol. 1988; 226:126–31.

22. Shin GS, Elliott RL, Rosenbaum AL. Posterior superior oblique tenectomy at the scleral insertion for collapse of A-pattern strabismus. J Pediatr Ophthalmol Strabismus. 1996; 33:221–8.

23. Wright KW. Superior oblique silicone expander for Brown’s syndrome and superior oblique overaction. J Pediatr Ophthal- mol Strabismus. 1991; 28:101–7.

24. Choi HY, Roh YB. Posterior tenotomy and tenectomy of superior oblique muscle in "A"pattern strabismus. J Korean Ophthalmol Soc. 1996; 37:1073–9.

25. Lee SY, Rosenbaum AL. Surgical results of patients with A-pattern horizontal strabismus. J AAPOS. 2003; 7:251–5.