Surgery for A and V Patterns

For an A or V pattern without significant oblique dysfunction, moving the horizontal rectus vertically at the time of strabismus surgery can eliminate the pattern
A-Pattern
- > 10 Prism Diopters in Upgaze vs Downgaze
- Move the medials UP 1/2 to 1 tendon width
- Move the laterals DOWN 1/2 to 1 tendon width
V-Pattern
- > 15 Prism Diopters in Upgaze vs Downgaze
- Move the medials DOWN 1/2 to 1 tendon width
- Move the laterals UP 1/2 to 1 tendon width
Surgery on the appropriate oblique muscles if they are dysfuctional can also treat the pattern
References:
- The Effect of Vertical Displacement of Horizontal Muscles on the Deviation in Primary Position. Kutsche and Keech 1988.
- Vertical offsets of horizontal recti muscles in the management of A and V pattern strabismus. Scott, Drummond, Keech 1989.