A case of constant exotropia with "V" pattern converted to "A" pattern

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  • Ｖ型からＡ型に移行した恒常性外斜視の１症例

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Purpose: To report a case of "V" pattern constant exotropia whose squint changed to "A" pattern exotropia at 5 years after recession-resection of horizontal muscles.<BR>Case: An 11 months old girl had constant exotropia with 50 prism diopter (PD) at her initial visit. Her eyes could not converge and had alternative fixation. She was slightly hypermetropic in both eyes. After 6 months’ unsuccessful convergence practice, we started to correct her exotropia with prism glasses. At 2 years and 8 months of age, "V" pattern exotropia was detected by synoptophore. Although her eyes showed slightly vertical deviations in the objective angle, ocular movement was normal with no over or under action of vertical muscles. After orthoptic training using synoptophore, "V" pattern was diminished but the angle of squint remained almost same. She underwent strabismus surgery with 8mm of lateral rectus recession and 6mm of medial rectus resection on her right eye at 4 years and 4 months old. After surgery, residual exodeviation was corrected by prism glasses and she was treated with orthoptic training. At 3 years and 6 months after surgery, dissociated vertical deviation was detected by synoptophore. At 5 years and 2 months after surgery, her squint changed to "A" pattern.<BR>Conclusions: Since "A" pattern may convert to "V" pattern, secondary and tertiary eye position should be carefully observed on following up the A-V strabismus.

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