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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
cause
Cause
  • Bilateral oblique muscle dysfunction
cause1
Cause….
  • Horizontal rectus muscle dysfunction
cause2
Cause….
  • Vertical rectus muscle dysfunction
clinical features
Clinical features
  • Measurement of the alignment in downgaze and upgaze
slide14

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

management
Management
  • Surgery for= Clinically significant pattern
surgery for pattern
Surgery for pattern
  • Most often in combination with correction of the underlying horizontal deviation
slide18

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

slide19

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

slide22

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

slide24

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

slide25

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

slide26

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)