Clinical Study of A-V Pattern Strabismus in Korea

Woo-Seok Chang; Sook-Young Kim

doi:10.3341/jkos.2008.49.12.1974

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Chang and Kim: Clinical Study of A-V Pattern Strabismus in Korea

Original Article

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

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.12.1974

Clinical Study of A-V Pattern Strabismus in Korea

Woo-Seok Chang, M.D., Sook-Young Kim, M.D.

¹Department of Ophthalmology, College of Medicine, Catholic University of Daegu, Daegu, Korea

Address reprint requests to Sook-Young Kim, M.D. Department of Ophthalmology, College of Medicine, Catholic University of Daegu #3056-6 Daemyung 4-dong, Nam-gu, Daegu 705-718, Korea Tel: 82-53-650-4739, Fax: 82-53-627-0133, E-mail: kimsy@cu.ac.kr

Received 2 September 2008 Accepted 28 May 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: A-V pattern, A esotropia, A exotropia, V esotropia, V exotropia

References

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Figure 1.

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

Table 1.

Distribution of A-V pattern strabismus in different reports in Korea

	Kim et al (%)	Woo and Chang (%)	Chang and Kim (%)
V-exotropia	4 (44.4)	9 (28.1)	74 (65.5)
A-exotropia	1 (11.1)	5 (15.6)	22 (19.5)
V-esotropia	4 (44.4)	1 (3.1)	9 (8.0)
A-esotropia	0 (0)	17 (53.1)	8 (7.1)
Total	9 (100.0)	32 (100.0)	113 (100.0)

Table 2.

Relative frequency of A and V pattern strabismus among 113 patients

	V pattern (%)	A pattern (%)	Total (%)
Exotropia	74 (65.5)	22 (19.5)	96 (85.0)
Esotropia	9 (8.0)	8 (7.1)	17 (15.1)
Total	83 (73.5)	30 (26.5)	113 (100)

Table 3.

Characteristics of patients with A-V pattern strabismus

	V-exotropia	A-exotropia	V-esotropia	A-esotropia
Age (years)	)	15.4±11.2	17.4±14.0	19.2±19.1	19.0±17.1
Sex (M/F∗)		33/41	7/13	4/5	6/2
BCVA^†	OD^‡	0.9±0.2	0.9±0.3	0.8±0.2	0.7±0.2
	OS	0.9±0.2	1.0±0.1	0.7±0.4	0.9±0.1
R.E^§	OD	-0.7±1.8	-0.3±1.7	0.2±2.8	-0.5±2.0
	OS	-0.8±2.2	-0.3±1.3	0.7±3.0	-0.4±1.7
Amblyopia		7/64 (10.9%)	4/13 (30.8%)	3/9 (33.3%)	2/8 (25.0%)
Titmus^∏		364.7±845.7	869.5±1193.5	548.9±948.9	1166.7±1594.8
AHP^#		19/64 (29.7%)	6/13 (46.1%)	2/9 (22.2%)	2/8 (25.0%)

^∗ M=male: F=female;

^† Best corrected visual acuity;

^‡ OD=right eye: OS=left eye;

^§ Refractive errors in spherical equivalen

^∏ Stereoacuity in seconds of arc by Titmus test

^# Abnormal head posture.

Table 4.

Preoperative and postoperative measurements in A-V pattern strabismus

	Preoperative deviation				Postoperative deviation
	Up	Primary	Down	Up-Down	Up	Primary	Down	Up-Down
V-exotropia	34.9±11.3	29.1±8.8	19.3±9.5	15.6±4.3	5.7±9.3	4.2±9.1	3.8±9.0	2.0±3.5
A-exotropia	22.8±14.7	28.9±14.7	36.4±16.0	-13.5±6.3	2.1±8.1	3.0±8.3	4.0±8.9	-1.9±3.6
V-esotropia	-14.6±7.3	-22.1±9.8	-30.5±10.7	15.9±5.6	-8.1±7.0	-7.3±6.6	-8.7±8.7	0.6±3.1
A-esotropia	-32.0±10.2	-26.5±10.8	-19.6±8.9	-12.4±5.6	-1.3±7.6	-1.1±6.7	-0.8±7.0	-0.4±0.7

Data represent mean±standard deviation in prism diopters; Plus (+) means divergent deviation angle, whereas minus (-) means convergent deviation angle.

Table 5.

Frequency and grade of oblique muscle dysfunction in A-V pattern strabismus

	Oblique muscle dysfunction (%)	Grade of oblique muscle dysfunction
V-exotropia	68/74 (91.8)	+2.0±1.2 (IOOA∗)
A-exotropia	17/22 (77.3)	+1.9±1.5 (SOOA^†)
V-esotropia	9/9 (100.0)	+1.7±1.0 (IOOA)
A-esotropia	4/8 (50.0)	+1.0±1.1 (SOOA)

^∗ IOOA=inferior oblique overaction;

^† SOOA=superior oblique overaction.

Table 6.

Surgical methods for A-V pattern strabismus

	Oblique muscle surgery (%)	Vertical transposition of horizontal rectus muscle (%)	Total (%)
V-exotropia	52 (70.3)	22 (29.7)	74 (100.0)
A-exotropia	10 (45.5)	12 (54.5)	22 (100.0)
V-esotropia	7 (77.8)	2 (22.2)	9 (100.0)
A-esotropia	4 (50.0)	4 (50.0)	8 (100.0)
Total	73 (64.6)	40 (35.4)	113 (100.0)

Table 7.

Collapse of pattern after surgery for A-V pattern strabismus

	Collapse of A-V pattern
	Oblique muscle surgery (%)	Vertical transposition of horizontal rectus muscle (%)	Total (%)
V-exotropia	49/52 (94.2)	22/22 (100.0)	71/74 (95.9)
A-exotropia	9/10 (90.0)	12/12 (100.0)	21/22 (95.5)
V-esotropia	7/7 (100.0)	2/2 (100.0)	9/9 (100.0)
A-esotropia	2/2 (100.0)	6/6 (100.0)	8/8 (100.0)
Total	67/71 (94.4)	42/42 (100.0)	109/113 (96.5)

Table 8.

Amount of decrease in A or V pattern after surgery

	Amount of decrease in A or V pattern
	Oblique muscle surgery	Vertical transposition of horizontal rectus muscle	P-value^†
V-exotropia	17.5±6.6∗	17.0±4.8	0.128
A-exotropia	12.9±7.1	11.8±3.4	0.400
V-esotropia	16.9±5.9	15.8±3.9	0.815
A-esotropia	12.0±0.1	12.7±6.1	0.889
Total	14.8±7.0	14.3±4.5	0.558

^∗ Mean±standard dev viation in prism diopters

^† Two sample t-test, p<0.05.

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