A-V pattern Horizontal strabismus
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A-V patternHorizontal strabismus
A R ZandiFeiz hospital
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Change in magnitude of deviation in upgaze and downgaze
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A-V pattern is a vertical incomittancy
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More convergent in upgaze compared with downgaze
A pattern
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More convergent in downgaze compared with upgaze
V pattern
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An A or V pattern is found in 15%-25% of horizontal strabismus
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Bilateral oblique muscle dysfunction
Cause
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IO overaction is associated with V pattern
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SO overaction is associated with A pattern
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These associations reflect the ancillary abducting action in upgaze and downgaze
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Horizontal rectus muscle dysfunction
Cause….
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Vertical rectus muscle dysfunction
Cause….
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Measurement of the alignment in downgaze and upgaze
Clinical features
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When in 25` from the primary position at least 10^ difference in deviation is detected, the clinically significant A pattern is present
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To be a clinically significant V pattern the difference must be at least 15^
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Surgery for= Clinically significant pattern
Management
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Most often in combination with correction of the underlying horizontal deviation
Surgery for pattern
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Patients with large A or V pattern usually also have significant corresponding oblique muscle dysfunction
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If the pattern is related to overaction of the oblique muscle,these are weakened as part of the surgical plan
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Weakening the IO muscles or tucking the SO tendons corrects up to 15-25^ of V pattern
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Bilateral SO tenotomy correct up to 35-45^ of A pattern(they produce 35-45^ esoshift in downgaze)
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Displacing the horizontal rectus muscle insertions is indicated when there is no oblique dysfunction
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The amount of displacement usually is ½ to a full tendon width
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MR are always moved toward the direction where convergence is greater or divergence is less(upward in A pattern and downward in V pattern)
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This displacement has no net horizontal,vertical or torsional effect in the primary position
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For example for V pattern when MR is displaced downward(and LR upward) in downgaze MR will be relaxed and the LR will be tightened( thereby decreasing the V pattern)
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MALE
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The muscle is moved in the direction in which the muscle`s horizontal effect is to be lessened
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