[Simultaneous horizontal and vertical surgery in esotropia]

The vertical syndrome depends on the triple action of the vertical muscles and includes vertical, alphabetical and torsional patterns; this syndrome is of major importance in the diagnosis and treatment of esotropia. We advise routine simultaneous surgery of the horizontal and vertical components. In congenital and early esotropias which occur before one year of age, extensive tests of sensorial evaluation cannot be carried out before three years of age and the vertical syndrome should therefore upon automatically be operated whatever its severity. The advantage of this type of surgery is unquestionable for removal of obstacles preventing recovery of a form of binocular vision. In acquired esotropias when good sensorial conditions (fusion, N.R.C., stereopsis) may be elicited after three years of age and when there is a minor vertical syndrome, vertical surgery might be considered as optional, but as vertical surgery is not dangerous, it can only be regarded as beneficial. With our surgical technique we obtain successful long-term results for horizontal deviation, which improves progressively (83%); vertical and alphabetical patterns improve in similar proportions (65 and 64% respectively). Surgical results depend on which of the following two forms of esotropia is present: in congenital and early esotropias a form of binocular vision with an angle of anomaly occurs almost without exception; in acquired esotropias a form of binocular vision without an angle of anomaly sometimes occurs. Overcorrections require second stage operation, which are simple and nonmutilating when the removal of convex glasses or the use of concave glasses does not reduce secondary exodeviation. Successful results of post-operative fusion confirm the beneficial influence of surgery on the vertical syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)