{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:48:36Z","timestamp":1793317716919,"version":"4.5.0"},"reference-count":28,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T00:00:00Z","timestamp":1659052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: To analyze demographic and clinical features of pattern strabismus patients and assess the relationship among these clinical variables and risk factors. Materials and Methods: Medical records of pattern strabismus patients who had undergone strabismus surgery at our center between 2014 and 2019 were retrospectively reviewed. Data collected included gender, age at onset, age at surgery, refraction, Cobb angle, pre- and post-operative deviations in the primary position, up- and downgaze, angle of ocular torsion, type\/amount of pattern, grade of oblique muscle function and presence\/grade of binocular function. To verify the clinical significance of the Cobb angle, 666 patients who had undergone surgery within one week after ocular trauma between 2015 and 2021 were enrolled as controls. Results: Of the 8738 patients with horizontal strabismus, 905 (507 males and 398 females) had pattern strabismus, accounting for 10.36%. Among these 905 patients, 313 showed an A-pattern and 592 showed a V-pattern. The predominant subtype was V-exotropia, followed by A-exotropia, V-esotropia and A-esotropia. Over half of these patients (54.6%) manifested an A- or V-pattern in childhood. The overall mean \u00b1 SD Cobb angle was 5.03 \u00b1 4.06\u00b0 and the prevalence of thoracic scoliosis was 12.4%, both of which were higher than that observed in normal controls (4.26 \u00b1 3.36\u00b0 and 7.8%). Within A-pattern patients, 80.2% had SOOA and 81.5% an intorsion, while in V-pattern patients, 81.5% had IOOA and 73.4% an extorsion. Patients with binocular function showed decreases in all of these percent values. Only 126 (13.9%) had binocular function, while 11.8% of A-pattern and 15.1% of V-pattern patients still maintained binocular function. Pre-operative horizontal deviation was negatively correlated with binocular function (r = \u22120.223, p &lt; 0.0001), while the grade of oblique muscle overaction was positively correlated with the amount of pattern (r = 0.768, p &lt; 0.0001) and ocular torsion (r = 0.794, p &lt; 0.0001). There were no significant correlations between the Cobb angle and any of the other clinical variables. There were 724 patients (80.0%) who had received an oblique muscle procedure and 181 (20.0%) who received horizontal rectus muscle surgery. The most commonly used procedure consisted of horizontal rectus surgery plus inferior oblique myectomy (n = 293, 32.4%), followed by isolated horizontal rectus surgery (n = 122, 13.4%). Reductions of pattern were 14.67 \u00b1 6.93 PD in response to horizontal rectus surgery and 18.26 \u00b1 7.49 PD following oblique muscle surgery. Post-operative deviations were less in V- versus A-pattern strabismus. Post-operative binocular function was obtained in 276 of these patients (30.5%), which represented a 16.6% increase over that of pre-operative levels. The number of patients with binocular function in V-pattern strabismus was greater than that of A-pattern strabismus (p = 0.048). Conclusions: Of patients receiving horizontal strabismus surgery, 10.36% showed pattern strabismus. In these patients, 54.6% manifested an A- or V-pattern in childhood, and V-exotropia was the most frequent subtype. Pattern strabismus patients showed a high risk for developing scoliosis. Cyclovertical muscle surgery was performed in 724 of these patients (80.0%), and horizontal rectus surgery was effective in correcting relatively small levels of patterns. Binocular function represented an important factor as being involved with affecting the occurrence and development of pattern strabismus.<\/jats:p>","DOI":"10.3390\/medicina58081018","type":"journal-article","created":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T02:06:42Z","timestamp":1659319602000},"page":"1018","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pattern Strabismus in a Tertiary Hospital in Southern China: A Retrospective Review"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4311-2988","authenticated-orcid":false,"given":"Binbin","family":"Zhu","sequence":"first","affiliation":[{"name":"Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangjun","family":"Wang","sequence":"additional","affiliation":[{"name":"Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Licheng","family":"Fu","sequence":"additional","affiliation":[{"name":"Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhua","family":"Yan","sequence":"additional","affiliation":[{"name":"Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/0002-9394(58)90995-4","article-title":"The Etiology of the So-Called A and V Syndromes","volume":"46","author":"Urist","year":"1958","journal-title":"Am. J. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"301256","DOI":"10.1155\/2013\/301256","article-title":"Pattern Strabismus: Where Does the Brain\u2019s Role End and the Muscle\u2019s Begin?","volume":"2013","author":"Ghasia","year":"2013","journal-title":"J. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"302","DOI":"10.3109\/09286586.2012.694553","article-title":"Prevalence of neurological involvement and malformative\/systemic syndromes in A- and V-pattern strabismus","volume":"19","author":"Dickmann","year":"2012","journal-title":"Ophthalmic Epidemiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1589\/jpts.28.1071","article-title":"Analysis of vastus lateralis and vastus medialis oblique muscle activation during squat exercise with and without a variety of tools in normal adults","volume":"28","author":"Lee","year":"2016","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_5","first-page":"329","article-title":"Macular ectopia and pseudoectopia due to rotation","volume":"79","author":"Weiss","year":"1966","journal-title":"Bull. M\u00e9moires Soci\u00e9t\u00e9 Fran\u00e7aise Dophtalmologie"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1001\/archophthalmol.2010.88","article-title":"Effect of ocular torsion on A and V patterns and apparent oblique muscle overaction","volume":"128","author":"Kushner","year":"2010","journal-title":"Arch. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"171","DOI":"10.3928\/0191-3913-19850901-04","article-title":"The role of ocular torsion on the etiology of A and V patterns","volume":"22","author":"Kushner","year":"1985","journal-title":"J. Pediatric Ophthalmol. Strabismus"},{"key":"ref_8","first-page":"81","article-title":"The 10th Bielschowsky Lecture. Changes in strabismus over time: The roles of vergence tonus and muscle length adaptation","volume":"21","author":"Guyton","year":"2006","journal-title":"Binocul. Vis. Strabismus Q"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Guyton, D.L. (2008). Ocular torsion reveals the mechanisms of cyclovertical strabismus: The Weisenfeld lecture. Investig. Ophthalmol. Vis. Sci., 49.","DOI":"10.1167\/iovs.07-0739"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.jaapos.2012.10.023","article-title":"Fusion can mask the relationships between fundus torsion, oblique muscle overaction\/underaction, and A- and V-pattern strabismus","volume":"17","author":"Deng","year":"2013","journal-title":"J. AAPOS"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"517","DOI":"10.6061\/clinics\/2013(04)13","article-title":"Static and dynamic postural control in low-vision and normal-vision adults","volume":"68","author":"Tomomitsu","year":"2013","journal-title":"Clinics"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1097\/00007632-200101010-00010","article-title":"Visual deficiency and scoliosis","volume":"26","author":"Catanzariti","year":"2001","journal-title":"Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1007\/s00417-018-4027-4","article-title":"Objective ocular torsion outcomes after unilateral horizontal rectus surgery in infantile esotropia","volume":"256","author":"Khanna","year":"2018","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1038\/s41433-019-0476-1","article-title":"Comparison of ocular torsion between congenital and acquired unilateral superior oblique palsy","volume":"33","author":"Kim","year":"2019","journal-title":"Eye"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1016\/j.ophtha.2009.03.047","article-title":"Observations about objective and subjective ocular torsion","volume":"116","author":"Kushner","year":"2009","journal-title":"Ophthalmology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ajo.2012.07.011","article-title":"Ocular torsion among patients with intermittent exotropia: Relationships with disease severity factors","volume":"155","author":"Shin","year":"2013","journal-title":"Am. J. Ophthalmol."},{"key":"ref_17","unstructured":"Bhola, R. (2022, January 01). Binocular Vision. Available online: http:\/\/eyerounds.org\/tutorials\/Bhola-BinocularVision.htm."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Mravicic, I. (2019). Binocular Functions. Eye Motility, IntechOpen Limited.","DOI":"10.5772\/intechopen.78731"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1148\/rg.307105061","article-title":"Scoliosis Imaging: What Radiologists Should Know","volume":"30","author":"Kim","year":"2010","journal-title":"Radiographics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1080\/09273972.2019.1697300","article-title":"The prevalence of tropia, phoria and their types in a student population in Iran","volume":"28","author":"Hashemi","year":"2020","journal-title":"Strabismus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"14","DOI":"10.4103\/0795-3038.179442","article-title":"Pattern of strabismus in a tertiary hospital in Nigeria: A six-year review","volume":"10","author":"Awoyesuku","year":"2016","journal-title":"Port. Harcourt Med. J."},{"key":"ref_22","first-page":"253","article-title":"Prevalence and pattern of strabismus in Ilorin","volume":"28","author":"Azonobi","year":"2009","journal-title":"West. Afr. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jaapos.2010.11.017","article-title":"Effect of vertical transposition of the medial rectus muscle on primary position alignment in infantile esotropia with A- or V-pattern strabismus","volume":"15","author":"Dickmann","year":"2011","journal-title":"J. AAPOS"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1016\/j.ophtha.2020.02.026","article-title":"Prevalence of Strabismus and Its Impact on Vision-Related Quality of Life: Results from the German Population-Based Gutenberg Health Study","volume":"127","author":"Elflein","year":"2020","journal-title":"Ophthalmology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"764","DOI":"10.3389\/fpsyg.2020.00764","article-title":"What Do Young Infants Do During Eye-Tracking Experiments? IP-BET\u2014A Coding Scheme for Quantifying Spontaneous Infant and Parent Behaviour","volume":"11","author":"Tomalski","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"134","DOI":"10.3341\/kjo.2016.0105","article-title":"Stereopsis before and after Inferior Oblique Weakening Surgery","volume":"32","author":"Seol","year":"2018","journal-title":"Korean J. Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"85","DOI":"10.3928\/0191-3913-19960301-05","article-title":"Inferior oblique overaction in infantile esotropia: Fundus extorsion as a predictive sign","volume":"33","author":"Eustis","year":"1996","journal-title":"J. Pediatr Ophthalmol. Strabismus"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1007\/s00586-020-06341-7","article-title":"Prevalence of the thoracic scoliosis in children and adolescents candidates for strabismus surgery: Results from a 1935-patient cross-sectional study in China","volume":"29","author":"Pan","year":"2020","journal-title":"Eur. Spine J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/8\/1018\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:59:12Z","timestamp":1760140752000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/8\/1018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,29]]},"references-count":28,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["medicina58081018"],"URL":"https:\/\/doi.org\/10.3390\/medicina58081018","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,29]]}}}