A and V patterns are manifest by a horizontal change of alignment of the eyes that occurs on midline upgaze and downgaze as the eyes are moved from the primary position. A and V patterns may be associated with orthophoria, esodeviation, or exodeviation in the primary position. Compensatory head postures are frequently found in patients having A and V patterns. A great deal has been written about the etiology, however, no single etiologic factor can explain all A and V patterns. A and V patterns are revealed by prism and alternate cover midline measurements, comparing 30 degrees upgaze, primary position, and 30 degrees downgaze. A difference of 15 delta between up and down measurements in V patterns and 10 delta in A patterns is necessary for a valid diagnosis. Some surgical methods were described to correct the A and V patterns, only two methods receive widespread acceptance: vertical transposition of the insertions of the horizontal rectus muscles and weakening of the oblique muscles. The authors studied clinically 8 cases of V patterns and 1 case of A pattern in 118 strabismic patients. The results were as follows; 1) The prevalence of A and V patterns was about 8%(9/118). 2) In V patterns, weakening procedures on the inferior oblique muscles with surgery on the horizontal rectus muscles corrected 7 delta to 12 delta between primary position and upgaze. And combining vertical transposition of horizontal rectus muscles corrected an additional 17 delta to 28 delta of V patterns between up and downgaze. 3) In A pattern, resecting inferior rectus muscle with surgery on the horizontal rectus muscles corrected 6 delta of A pattern.
Diagnosis ; Esotropia ; Exotropia ; Head ; Humans ; Muscles ; Posture ; Prevalence

PURPOSE: The purpose of this study is to provide useful clinical information for proper diagnosis of the superior oblique muscle palsy (SOP) associated with horizontal deviation. METHODS: The records of 186 patients with SOP treated surgically were reviewed. The patients who underwent surgery for horizontal deviation more than 10 PD were classified into SOP associated with horizontal deviation. RESULTS: Of 186 patients with SOP, 96 (51.6%) patients also showed horizontal deviation. In 59 patients (61.5%) of these 96 patients, chief complaint was horizontal deviation only and 24 patients (25.0%) knew their hyperdeviation. Compensatory head-tilt was shown in 52 patients (54.2%), however only 11 (11.5%) patients complained their head-tilt posture. Of 96 patients, 72 (82.3%) had horizontal deviation in the eye contralateral to the paretic eye and amblyopia occurred in the horizontally deviated eye. The frequency of exodeviation was 82.3 % and was more than that of esodeviation. The mean amount of hyperdeviation was 12.6 +/- 6.77 PD, and that of horizontal deviation was 22.9 +/- 8.13 PD in exodeviation and 22.5 +/- 9.17 PD in esodeviation, respectively ninety three patients (96.9%) showed positive Bielschowsky head-tilt test. All 83 patients who had fundus examination showed foveal extorsion. CONCLUSIONS: This study reveals that Bielschowsky head-tilt test and fundus examination for foveal extorsion are needed to diagnose SOP which is masked by prominent horizontal deviation.
Amblyopia ; Diagnosis ; Esotropia ; Exotropia ; Humans ; Masks ; Paralysis ; Posture

We retrospectively reviewed the medical records of 282 consecutive patients with the diagnosis of exotropia and analyzed the clinical factors related to amblyopia. The average age was 4.8 years old(138 males, 144 females). The results of analysis run as follows. First, in exotropia, the prevalence of the amblyopia was 19.8%, the detection of exotropia in the group with amblyopia was earlier than the group without (p<0.05), the degree of anisometropia was greater, the prevalence of significant anisometropia(more than 1.0 diopter in spherical equivalent) was higher. Second, The presence of amblyopia and the degree of correction of amblyopia before the surgery did not relate with the surgical success rate. Third, the recurrence rate of cured amblyopia after termination of occlusion therapy was 10.8%, the recurrence rate and the developement of amblyopia after surgery were 11.2%, 5.5% respectively. In orthotropia and esotropia after surgery, the recurrence rate of amblyopia and development of amblyopia were high.
Amblyopia* ; Anisometropia ; Child* ; Diagnosis ; Esotropia ; Exotropia* ; Humans ; Male ; Medical Records ; Prevalence ; Recurrence ; Retrospective Studies

PURPOSE: In this study we evaluated the prognostic factors by comparing the clinical manifestation of consecutive exotropia after consecutive exotropia surgery. METHODS: We performed a retrospective study of 65 patients who had surgery due to consecutive exotropia after esotropia surgery in Yeungnam University Medical Center between July 1988 and December 2013. The type of esotropia, age at diagnosis of esotropia, type of esotropia surgery, age at esotropia surgery, type of consecutive exotropia surgery, age at consecutive exotropia surgery, presence of adduction limitation, presence of amblyopia, and preoperative and postoperative angles of strabismus were analyzed. RESULTS: The mean follow-up time after consecutive exotropia surgery was 5.1 +/- 5.2 years and 50 of 65 patients showed successful surgical outcomes at the last follow-up. Cumulative success rate of consecutive exotropia remained stable postoperatively in 68.2% of patients after 7.7 years. When comparing the success group and the recurrent group, the age at consecutive exotropia surgery was significantly younger and mean follow-up time was significantly longer in the recurrent group. The mean interval between consecutive exotropia surgery and recurrence of exotropia was 16.9 months in the recurrent group. The mean angle of strabismus at postoperative 1 week was significantly different between the 2 groups; 0.5 prism diopters (PD) esodeviation in the success group and 4.5 PD exodeviation in recurrent group. CONCLUSIONS: Recurrence of consecutive exotropia frequently developed with younger age at consecutive exotropia surgery and exodeviation at postoperative 1 week. Recurrent consecutive exotropia should be observed for an extended period, thus requiring periodic long-term postoperative follow-ups.
Academic Medical Centers ; Amblyopia ; Diagnosis ; Esotropia ; Exotropia* ; Follow-Up Studies ; Humans ; Recurrence ; Retrospective Studies ; Strabismus

PURPOSE: To investigate the trend of refractive change in hyperopic patients according to increases in age. METHODS: Eighty-eight children who had hyperopia of more than +1.50 diopters (D) and could be followed up for at least 5 years were included in this study. We divided the patients into two groups according to the level of initial hyperopia and retrospectively analyzed hyperopic refractive changes over a 5-year period according to age at initial diagnosis, presence of esotropia, amblyopia, astigmatism and anisometropia. RESULTS: We gained the following formula about the aspect of hyperopic reduction in 88 patients over a period of 5 years: Diopter (D)=7.99-2.14 Ln (age). The presence of anisometropia and amblyopia did not affect hyperopic reduction. Hyperopic reduction amounts in the group with a hyperopic eye of more than +5D at initial diagnosis were greater than in the group with a hyperopic eye less than +5D, and greater in the group with an astigmatic eye of more than 1D. The presence of esotropia and the age at initial diagnosis did not affect hyperopic reduction. CONCLUSIONS: We show that emmetropization in hyperopic children occurs according to the following formula: Diopter (D)=7.99-2.14 Ln (age). Both the initial level of hyperopia and the concurrent presence of astigmatism affected hyperopic reduction. However, the presence of anisometropia, amblyopia, esotropia and the age at initial diagnosis did not significantly affect hyperopic reduction.
Amblyopia ; Anisometropia ; Astigmatism ; Child ; Diagnosis ; Esotropia ; Follow-Up Studies* ; Humans ; Hyperopia ; Retrospective Studies

PURPOSE: This study was designed to determine the recurrence rate, the recurrence time after surgical correction of intermittent exotropia and the relationships between the factors and the surgical outcome of intermittent exotropia. METHODS: The surgical results were retrospectively investigated in 210 patients who had undergone surgery for intermittent exotropia with at least 3 months (average 26.3 months, range 1~65 months) after surgical correction. Surgical success was defined as a final distance and near deviation less than 10PD at primary position. Overcorrection was defined as a final distance and near esodeviation more than 10PD at primary position over 3 months. Recurrence was defined as a final distance and near exodeviation more than 10PD at primary position. We investigated the recurrence rate according to the follow-up duration with survival analysis. RESULTS: Out of 210 patients, surgical success was achieved in 130 patients (61.9%), overcorrection was achieved in 7 patients (3.3%) and recurrence occurred in 73 patients (34.8%). As a result of surgical analysis, survival period (the time interval from onset to initial surgery) was from 1 to 65 months (mean 21.3 months). As the follow-up duration increased, the recurrence rate increased progressively. The factors including age at diagnosis, age at onset, age at surgery contribute significantly to the early recurrence. The factors including exodeviation at postoperative 1 day and 1 week, duration of exotropia contribute significantly to the late recurrence. CONCLUSIONS: The factors including age, exodeviation at postoperative 1 day and 1 week, duration of exotropia and follow-up duration did contribute significantly to the recurrence. By these factors, we can estimate the proper time of surgery and the prognosis after surgical correction of intermittent exotropia.
Diagnosis ; Esotropia ; Exotropia* ; Follow-Up Studies ; Humans ; Prognosis ; Recurrence* ; Retrospective Studies ; Survival Analysis

PURPOSE: To study the clinical characteristics of pediatric sensory strabismus in Korean children. METHODS: A retrospective analysis was performed on 71 patients with the diagnosis of sensory strabismus before the age of 16 years. Patients with strabismic amblyopia or anisometropic amblyopia were excluded from consideration. The age at onset of vision loss, diagnosis, type of strabismus, deviated angle, etiologic factors leading to vision loss, and visual acuity of the deviated eye were recorded. The surgical results were analyzed in the case of strabismus surgery for sensory strabismus. RESULTS: The mean age at the onset of vision loss was 4.6 years and the mean age at diagnosis was 7.5 years. Forty-one patients (58%) had congenital vision loss and the most common cause of vision loss was optic nerve disease in 35 (49%). Exotropia developed in 58 (82%), and patients with severely impaired visual acuity were more likely to develop exotropia (P=0.054). The age at the onset of vision loss and the age at diagnosis in esotropia were younger than in exotropia (P=0.049, P=0.047, respectively). Twenty-five (78%) of 32 patients who had undergonewere strabismus surgery had ocular alignment within 10 prism diopters of orthophoria. The frequency of consecutive exotropia was 40% in surgery for esotropia. CONCLUSIONS: Children with organic amblyopia tend to develop sensory exotropia. We considered that the age at initial vision loss and the severity of vision loss could play a role in determining the direction of deviation. The surgical results were favorable, but we should pay attention to the development of consecutive exotropia in surgery for esotropia.
Amblyopia* ; Child* ; Diagnosis ; Esotropia ; Exotropia ; Humans ; Optic Nerve Diseases ; Retrospective Studies ; Strabismus* ; Visual Acuity

PURPOSE: The epicanthal fold in Korean children is a common cause of pseudoesotropia. Therefore, the present study was undertaken to evaluate the clinical characteristics of strabismus in children diagnosed with pseudoesotropia. METHODS: We reviewed the charts of children diagnosed with strabismus from February 2004 to January 2005. Strabismic children with a history of pseudoesotropia were included in this study. We recorded the age and chief complaints at the time of pseudoesotropia diagnosis as well as the type of strabismus, the visual acuity, chief complaints, and refractive error at the time of strabismus diagnosis. RESULTS: One hundred and two of 734 children with strabismus (13.9%) had a history of pseudoesotropia. The mean age at the time of pseudoesotropia diagnosis was 2.9 years. The mean age at the time of strabismus diagnosis was 4.4 years. The type of strabismus was exotropia in 58 (56.9%) and esotropia in 39 (38.2%) cases. Refractive accommodative esotropia was seen in 89.7% of esotropia cases and the basic type was seen in 86.2% of exotropia cases. The concurrence rate between chief complaints of pseudoesotropia and the type of strabismus diagnosed was lower in exotropia than in esotropia. There was hyperopia in all the esotropia cases, and the distribution of refractive error was variable in exotropia. The frequency of amblyopia was 19.6%. CONCLUSIONS: The incidence of strabismus is high in the case of children diagnosed with pseodoesotropia. Therefore, regular examinations for strabismus, refractive error and amblyopia may be necessary.
Amblyopia ; Child* ; Diagnosis ; Esotropia ; Exotropia ; Humans ; Hyperopia ; Incidence ; Refractive Errors ; Strabismus ; Visual Acuity

PURPOSE: To investigate the ophthalmologic manifestations of Korean patients with Gaucher disease. METHODS: Clinical records of 5 patients who were referred to the pediatric ophthalmology clinic of Seoul National University Bundang Hospital after diagnosis of Gaucher disease at the genetics clinic of Ajou University Hospital between 2007 and 2008 were retrospectively reviewed. RESULTS: Five patients with type 3 Gaucher disease had hepatosplenomegaly and oculomotor apraxia, and 4 patients had growth and developmental delay. The most commonly detected genetic mutation was L444P. In addition, P201H, F2131, R257Q, and D315E+Rec 1b were identified. Five patients had oculomotor apraxia and limitation of abduction, and 4 patients had esotropia. One of the 4 patients who showed combined limitation of abduction, oculomotor apraxia, and esotropia, yet did not have growth and developmental delay. CONCLUSIONS: Most of the patients who were referred for ocular motor abnormalities with Gaucher disease showed a limitation of abduction, oculomotor apraxia, and esotropia. In patients with a limitation of abduction, oculomotor apraxia, and esotropia, Gaucher disease should be considered. Ophthalmologic examination is essential for subtyping and prognosing Gaucher disease.
Apraxias ; Diagnosis ; Esotropia ; Gaucher Disease* ; Genetics ; Growth and Development ; Humans ; Lysosomal Storage Diseases ; Ophthalmology ; Retrospective Studies ; Seoul

We present the retrospective study to identify the clinical characteristics and the results of surgical correction for 50 patients with diagnosis of infantile esotropia at Soonchunhyang Chunan University Hospital from January 1990 to August 1994. The following results were obtained. Of 50 patients, 29(58%) patients were male and 21(42%)patients were female. Initial visit was most common between age of 2 and 3 years. 14% of patients were seen at age of 2 years or less. Average initial visit was 5.16 years. Esotropia was noted most commonly 2 to 4 month after birth in 23 patients(46%). Preoperative deviation angle was over 30PD in 88% of patients, and preoperative cycloplegic refraction showed +2.0D-O in 62%. The prevalence of associated findings such as amblyopia, dissociated vertical deviation(DVD), inferior oblique muscle overaction, and nystagmus were 32%, 14%, 38%, 4% by sequence. Surgical correction was performed before age of 2 year if noted at initial visit. The average age of surgical correction was 5.42 years. Bilateral medial rectus muscle recessions were performed in 30%, Unilateral resection and recession were performed in 35 patients(70%), Orthophoria(within +10 prism diopters) was achieved in 58% of the patients postoperatively. In 16% of patients residual esotropia of more than 20PD remained, which required further operation. These patients had average preoparative esotropia of 51PD and amblopia and inferior oblique overaction were seen in 87.5% preoperatively. We found that the two variables of amblyopia and inferior oblique muscle overaction lead to less satisfactory outcomes(P<0.01). Since amblyopia and inferior oblique muscle overaciton were seen more commonly in those patients that required reoperation. The average follow up time was 9.4 months.
Amblyopia ; Chungcheongnam-do ; Diagnosis ; Esotropia* ; Female ; Follow-Up Studies ; Humans ; Male ; Parturition ; Prevalence ; Reoperation ; Retrospective Studies