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Combined horizontal and oblique muscle surgery to treat synergistic divergence.

CAN J OPHTHALMOL—VOL. 44, NO. 5, 2009 611 malities have been associated with chromosome 9 inversion, including dysmorphic features (short stature, depressed nasal bridge, down-slanting eyes, low-set ears, hypertelorism), microcephaly, deafness, ectodermal dysplasia (absent sweat glands, hypotrichosis, hypodontia), repeated spontaneous abortion, infertility (absence of ovaries, hypoplastic uterus, oligozoospermia), developmental and psychomotor delay, as well as psychiatric disorders. Congenital cataract and blindness have rarely been reported. Optic nerve hypoplasia is the most common congenital disc anomaly, occurring in 6.3 out of 100 000 children, and is a leading cause of blindness in infants and toddlers. It is often associated with midline cerebral defects, including absent septum pellucidum and agenesis of corpus callosum, constituting the De Morsier syndrome or septo-optic dysplasia.5 Many prenatal insults have been linked to the development of optic nerve hypoplasia, including maternal smoking and ingestion of anticonvulsant medications, alcohol, quinine, and antidepressants, as well as maternal diabetes and congenital cytomegalovirus or hepatitis B infection. Genetic disorders known to be associated with optic nerve hypoplasia are trisomy 18, Cri-du-chat syndrome (5p deletion), PAX6, HESX1, SOX2, and SOX3 gene mutations. To the best of our knowledge, this is the first report of optic nerve hypoplasia associated with chromosome 9 inversion. Whether there is a true association between these 2 conditions or whether they are coincidental findings in our patient remains to be elucidated.