Vertical Recti Transplantation in the A and V Syndromes

Abstract

The A and V syndromes are a graphic description of the variation in the amount of horizontal strabismus as the patient looks up and down. These exist in both esotropia and exotropia. The A-type esotropia demonstrates an increase in the internal strabismus on upward gaze, and a decrease on downward gaze (Fig. 1<i>A</i>). The V esotropia presents more strabismus in the down position and less in the up (Fig. 1<i>B</i>). Exotropia with A phenomenon has more outward deviation in depressed gaze and less in elevated gaze (Fig. 2<i>A</i>). The V exotropia is the opposite, with the greatest amount of outward deviation while looking up (Fig. 2<i>B</i>). This variation in the amount of strabismus ranges from insignificant to as high as 80 D. Often there is an accompanying over or underacting vertical muscle, particularly the obliques. The V syndromes may have overacting inferior obliques, while in the