Treatment of A-pattern esotropia with marked mongoloid slanting palpebral fissures.
BACKGROUND
The association of oblique palpebral fissures and A- or V-pattern has not been clarified. We report two cases of A-pattern esotropia with marked mongoloid slanting palpebral fissures associated with vertical displacement of the horizontal rectus muscle.


METHODS
Case 1 was a boy with Prader-Willi syndrome. He showed A-pattern esotropia with upward slanting palpebral fissures. Severe superior oblique muscle overaction was observed. Case 2 was a girl with meningocele. She also showed A-pattern esotropia with upward slanting palpebral fissures.


METHODS
In case 1, weakening surgery of the superior oblique muscles did not improve the A-pattern. Coronal images of computed tomography showed one-half-muscle-width upward displacement of both lateral rectus muscles. After downward transposition surgery of the lateral rectus muscles, the preoperative A-pattern of 25 prism diopters (PD) was successfully corrected to 10 PD. In case 2 also, upward displacement of both lateral rectus muscles was shown by computed tomography. The preoperative A-pattern of 26 PD was corrected to 4 PD postoperatively after upward transposition surgery of the medial rectus muscles.


CONCLUSIONS
The vertical displacement of horizontal rectus muscles was considered the principal cause of A-pattern in these cases associated with marked mongoloid slanting palpebral fissures.
Hatsukawa
Y
Y
Eye Department, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Ishizaka
M
M
Nihmi
A
A
Mitarai
K
K
Furukawa
A
A
Yamagishi
T
T
D002675:Child, Preschool; D004948:Esotropia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005141:Eyelid Diseases / Q000150:complications*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008588:Meningocele / Q000150:complications; D009801:Oculomotor Muscles / Q000000981:diagnostic imaging / Q000637:transplantation*; D011218:Prader-Willi Syndrome / Q000150:complications; D014057:Tomography, X-Ray Computed