Surgical Correction of V-pattern Esotropia and Inferior Oblique Overaction in a Patient with Craniosynostosis

Purpose: We describe the use of bilateral medial rectus recession with inferior transposition and inferior oblique myectomy to treat a patient with craniosynostosis exhibiting V-pattern esotropia and inferior oblique overaction. Case summary: An 8-year-old girl with esotropia and a history of cranioplasty for craniosynostosis visited our clinic. Her best-corrected visual acuity (BCVA) was 0.5 and 0.3 in the right and left eye, respectively. Latent nystagmus was observed in both eyes. She exhibited 40 prism diopters (PD) of esotropia in the primary position, 30 PD during upgaze, and 45 PD during downgaze. Bilateral superior oblique underaction and inferior oblique overaction were observed. Fundus examination revealed excyclotorsion in both eyes. Computed tomography (CT) revealed superior displacement of both medial rectus muscles. She underwent 5.5-mm medial rectus recession with inferior transposition and inferior oblique myectomy in both eyes. After 9 months, she exhibited 5 PD of dissociated vertical deviation at far distance in the right eye, and 10 PD of exotropia with 5 PD of dissociated vertical deviation at near distance. Ductions and versions were within the normal range in both eyes. Conclusions: Bilateral medial rectus recession with inferior transposition and inferior oblique myectomy is useful in patients exhibiting V-pattern esotropia and inferior oblique overaction in association with craniosynostosis.