a v pattern horizontal strabismus n.
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A-V pattern Horizontal strabismus. A R Zandi Feiz hospital. Change in magnitude of deviation in upgaze and downgaze. A-V pattern is a vertical incomittancy. A pattern. More convergent in upgaze compared with downgaze. V pattern. More convergent in downgaze compared with upgaze.

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a v pattern horizontal strabismus

A-V patternHorizontal strabismus

A R Zandi

Feiz hospital

a pattern
A pattern
  • More convergent in upgaze compared with downgaze
v pattern
V pattern
  • More convergent in downgaze compared with upgaze
  • Bilateral oblique muscle dysfunction
  • Horizontal rectus muscle dysfunction
  • Vertical rectus muscle dysfunction
clinical features
Clinical features
  • Measurement of the alignment in downgaze and upgaze

When in 25` from the primary position at least 10^ difference in deviation is detected, the clinically significant A pattern is present

  • Surgery for= Clinically significant pattern
surgery for pattern
Surgery for pattern
  • Most often in combination with correction of the underlying horizontal deviation

Patients with large A or V pattern usually also have significant corresponding oblique muscle dysfunction


If the pattern is related to overaction of the oblique muscle,these are weakened as part of the surgical plan


Displacing the horizontal rectus muscle insertions is indicated when there is no oblique dysfunction


MR are always moved toward the direction where convergence is greater or divergence is less(upward in A pattern and downward in V pattern)


This displacement has no net horizontal,vertical or torsional effect in the primary position


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)