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A V Patterns (Alphabetical Syndrome) Management

 
Dr Sudhir Singh , MS
JW Global Hospital Research Centre
Mount Abu India 307501
 

Definition : AV Patterns

  • A Pattern: Minimum of 10 prism dioptre of difference between up and down gaze

  • V Pattern: - Minimum of 15 prism dioptre difference between up and down gaze

 

Etiology

1.The vertical school of Brown (1963

2.The horizontal school of Urist (1951 -58).

      . Oblique Muscle Defect

         Rectus Muscle Defect

3.Combined School

A  Pattern  Deviations

  • A Pattern Eso Deviation :Convergent deviation increases in up gaze and decreases in down gaze.

  • A Pattern Exo Deviation : Divergent deviation increases in down gaze up gaze

 

A V Patterns (Alphabetical Syndrome) Management Graphical Presentation and Slide Show

 

V  Pattern  Deviations

       V Pattern- Eso Deviation: Convergent deviation increases in down gaze and decreases in up gaze.

       V Pattern- Exo Deviation : Divergent deviation increases in up gaze and decreases in down gaze.

 

Other Pattern  Deviations

       X- pattern: Relative divergence on up and down gaze.

       Y- pattern: Eyes go out in up gaze, but straight alignment in primary and down gaze.

       Inverted Y- pattern (Lambda pattern): Exotropia in down gaze only.

       Diamond pattern: Relative convergence on both Up  and down gaze.

 

Management of AV Patterns

 
When obliques muscles are normal
Horizontal muscles transposition : Medial rectus shifted half to one  tendon width toward apex of A or V pattern and lateral rectus muscles shifted half to one  tendon width toward  empty space.

When obliques muscles are abnormal
Inferior Oblique Over Action (IOOA) :Responsible for V  patterns
Inferior Oblique Weakening: Procedure
  • Tenotomy
  • Myectomy
  • Recession
  • Recession With Anterior Transposition
     
Superior  Oblique Over Action (SOOA):
Superior Oblique Weakening Procedure:Responsible for V  patterns
  • Superior Oblique Posterior Tenotomy
  • Superior Oblique Tenotomy
     
 
 
 

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  • AC /A Simulator And Calculator
  • A V Patterns Simulator And Calculator
  • Parks 3 Step Test
  • Knapp's Classification
  • Simulator for ductions,versions and grades of oblique muscles over action
  • Classification and management of Duane's Retraction Syndrome
  • Management of third nerve palsy
  • Management of forth nerve palsy
  • Management of sixth nerve palsy
  • Management of Browns Syndrome
  • Management of double elevator palsy

 

 

 

 

 

 

 

 

 

 

 

 

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