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Purpose: To determine whether bilateral superior rectus recession modifies A and V pattern strabismus., Patients and Methods: Three patients with V patterns and eight patients with A patterns underwent bilateral superior rectus recession with neither oblique muscle surgery nor vertical displacement of the horizontal rectus muscles. Another three patients with A patterns underwent simultaneous superior oblique tenotomy and superior oblique recession., Results: Two of the patients with V patterns demonstrated an increase in the V pattern after surgery; one was unchanged. Five of the patients with A patterns converted to V patterns after surgery. In the remaining three patients the pattern was eliminated. The three patients who underwent superior oblique tenotomy along with superior rectus recession had large shifts toward V pattern (mean shift, 40 delta)., Conclusion: Bilateral superior rectus recession tends to increase V patterns and reduce A patterns. Superior rectus recession may be synergistic with superior oblique tenotomy in collapsing an A pattern.

Infantile esotropia with nystagmus in abduction is characterized by early onset, jerk nystagmus in abduction, and dissociated vertical deviation, among other features. Electro-oculographic tracings present easily recognizable patterns both in saccadic and pursuit movements. Visual evoked responses are asymmetric in most cases and optokinetic nystagmus is invariably asymmetric. Visual cortex maldevelopment seems to play a major pathogenic role. Recent findings in myelomeningocele and in patients with posterior fossa tumors suggest that pathological alterations in this area may tend to induce similar anomalies in electro-oculographic and optokinetic nystagmus recordings. Posterior fossa damage or impairment is therefore suspected to be a possible causative factor in the development of infantile esotropia with nystagmus in abduction.

The authors reported 3 cases of complete lateral rectus palsy treated with the Carlson-Jampolsky transposition technique with readjustable sutures. A fair balance in the primary position with adduction and abduction around 20 degrees were obtained. The EOG tracings recorded in all the cases prior and after surgery showed interesting aspects of this improvement both in the saccadic velocities, and in the amplitude of the movements. The follow up of these patients, up to two years, did not show any impairment of the results.

Visually evoked potentials (VER) were studied in 16 patients over 3 months of age with congenital or very early loss of vision in one eye. Seven patients (group I) developed an oculomotor syndrome in the sound eye characterized by jerky nystagmus in abduction, adduction fixation preference, and head-turn toward the side of the fixating eye. The other nine patients (group II) failed to develop the above-described syndrome. In group I, VER response asymmetry was found in six cases, with crossed predominance in four and direct predominance in two. The 7th patient showed a symmetric response. In group II, eight of the nine patients showed symmetric VER responses, and one showed asymmetric response with crossed predominance. Recorded VER asymmetries seem to correlate with oculomotor disturbances.