Z-tenotomy of the superior oblique tendon and horizontal rectus muscle surgery for A-pattern horizontal strabismus

PURPOSE Few studies have investigated combined surgeries for horizontal deviation and A pattern caused by superior oblique overaction (SODA). This study presents our experience with combined surgery and examines the effect of the type of strabismus and prior surgery on outcome. METHODS The medical records of patients who underwent combined surgery for horizontal deviation Occurring with A-pattern misalignment from 2000 through 2004 were reviewed. The procedure consisted of horizontal extraocular muscle recession or resection with superior oblique Z-tenotomy. The criteria for surgical success were horizontal deviation at primary gaze of <= 10(Delta), A pattern of <= 10(Delta), and SOOA of <= 1.0. RESULTS The study group included 28 patients with a mean age of 13.4 years. Thirteen (46.4%) had A-pattern esotropia; 15 (53.6%) had A-pattern exotropia. Fifteen (50%) had undergone previous surgery. The success rate for the whole group was 60.7%. There was no statistically significant difference in success rate between patients with esotropia (53.8%) or exotropia (66.7%) (p = 0.48) or between patients in whom the combined procedure was the primary (71.4%) or secondary (50.0%) treatment (p = 0.246). Measurements of horizontal strabismus remained stable throughout follow-up in the esotropia group but were unpredictable in the exotropia group. CONCLUSIONS The success rate of combined horizontal deviation/A-pattern surgery is unaffected by type of horizontal deviation or prior surgery. (J AAPOS 2009;13:27-30)