title: Bilateral posterior tenectomy of the superior oblique muscle for the treatment of A-pattern strabismus.
abstract: OBJECTIVE
  To evaluate the efficacy of bilateral posterior superior oblique tenectomy for the treatment of A-pattern strabismus due to superior oblique overaction regardless of the magnitude of the pattern.
  
  
  METHODS
  The medical records of patients with A-pattern esotropia or exotropia in the presence of superior oblique overaction who underwent combined horizontal muscle surgery along with bilateral superior oblique posterior 7/8 tenectomy from 2003 to 2013 were retrospectively reviewed. Patients with at least 3 months' follow-up were included.
  
  
  RESULTS
  A total of 73 patients were included. Of these, 46 had esotropia; 27, exotropia. The preoperative A-pattern deviation for the study population was 19.6(Δ) ± 11.4(Δ) (range, 10-60), with a final postoperative patten collapse of 18.2 ± 3.6. Superior oblique overaction was 2.3 ± 0.7 preoperatively and 0.3 ± 0.7 postoperatively. Overall, 87.7% of patients had a successful collapse of their pattern to <10(Δ) following the initial bilateral superior oblique posterior tenectomy, with an additional 4.1% following a second procedure. Of patients with a pattern deviation of <25(Δ), 87.9% had successful collapse of the pattern following 1 surgery, and 86.7% of patients who had a pattern of ≥25(Δ) had successful collapse. Postoperatively, 7 patients demonstrated mild inferior oblique overaction. No surgical complications were noted.
  
  
  CONCLUSIONS
  A uniform dose of bilateral posterior 7/8 tenectomy surgery successfully collapses A-pattern deviations of all magnitudes.
authors.affiliation: Pediatric Ophthalmic Consultants, New York; New York University Langone Medical Center, New York.
authors.forename: Milan P
authors.initials: MP
authors.lastname: Ranka
authors.affiliation: Pediatric Ophthalmic Consultants, New York; New York University Langone Medical Center, New York.
authors.forename: Grace T
authors.initials: GT
authors.lastname: Liu
authors.affiliation: Pediatric Ophthalmic Consultants, New York; New York University Langone Medical Center, New York.
authors.forename: Julie N
authors.initials: JN
authors.lastname: Nam
authors.affiliation: Pediatric Ophthalmic Consultants, New York; New York University Langone Medical Center, New York.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Lustig
authors.affiliation: Pediatric Ophthalmic Consultants, New York; New York University Langone Medical Center, New York.
authors.forename: Shirah R
authors.initials: SR
authors.lastname: Schwartz
authors.affiliation: Pediatric Ophthalmic Consultants, New York; New York University Langone Medical Center, New York.
authors.forename: Lisabeth S
authors.initials: LS
authors.lastname: Hall
authors.affiliation: Pediatric Ophthalmic Consultants, New York; New York University Langone Medical Center, New York.
authors.forename: Louis E
authors.initials: LE
authors.lastname: Furlan
authors.affiliation: Pediatric Ophthalmic Consultants, New York; New York University Langone Medical Center, New York.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Ceisler
authors.affiliation: Pediatric Ophthalmic Consultants, New York; New York University Langone Medical Center, New York. Electronic address: Steele@pedseye.com.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Steele
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004948:Esotropia / Q000601:surgery*; D005099:Exotropia / Q000601:surgery*; D005133:Eye Movements / Q000502:physiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery*; D058971:Tenotomy; D020432:Trochlear Nerve Diseases / Q000601:surgery*; D015348:Vision, Binocular / Q000502:physiology