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Kang H, Shin HJ, Lee AG. Risk of consecutive esotropia after surgery for intermittent exotropia according to passive duction force. PLoS One 2023; 18:e0281392. [PMID: 36795708 PMCID: PMC9934408 DOI: 10.1371/journal.pone.0281392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/22/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE To determine the relationship between consecutive esotropia (ET) and passive duction force (PDF) in patients with intermittent exotropia (XT). METHODS The study enrolled 70 patients in whom PDF was measured under general anesthesia prior to XT surgery. The preferred eye for fixation (PE) and the nonpreferred eye for fixation (NPE) were determined using a cover-uncover test. The patients were subdivided into two groups according to the angle of deviation at 1 month postoperation: (1) consecutive ET (CET group), >10 prism diopters (PD) of ET; and (2) non-CET (NCET group), ≤10 ET or residual exodeviation. The relative PDF of the medial rectus muscle (MRM) was obtained by subtracting the ipsilateral PDF of the lateral rectus muscle (LRM) from the PDF of the MRM. RESULTS The PDFs for the LRM in the PE in the CET and NCET groups were 47.28 g and 58.59 g, respectively (p = 0.147), and 56.18 g and 46.59 g for the MRM (p = 0.11), and in the NPE were 59.84 g and 55.25 g, respectively, for the LRM (p = 0.993), and 49.12 g and 50.53 g, respectively, for the MRM (p = 0.81). However, in the PE, the PDF in the MRM was larger in the CET group than in the NCET group (p = 0.045), which was positively associated with the postoperatively overcorrected angle of deviation (p = 0.017). CONCLUSIONS An increased relative PDF in the MRM in the PE was a risk factor for consecutive ET after XT surgery. Quantitative evaluation of the PDF could be considered when planning strabismus surgery to achieve the desired surgical outcome.
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Affiliation(s)
- Hyunkyoo Kang
- Department of Mechatronics Engineering, Konkuk University Glocal Campus, Chungcheongbuk-do, Republic of Korea
| | - Hyun Jin Shin
- Department of Ophthalmology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea,* E-mail:
| | - Andrew G. Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, United States of America,Department of Ophthalmology, Neurology, Neurosurgery, Weill Cornell Medicine, New York, NY, United States of America,Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, United States of America,Department of Ophthalmology, UT MD Anderson Cancer Center, Houston, TX, United States of America,Department of Ophthalmology, Texas A and M College of Medicine, College Station, TX, United States of America,Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States of America,Department of Ophthalmology, Baylor College of Medicine and the Center for Space Medicine, Houston, TX, United States of America,Department of Ophthalmology, University of Buffalo, Buffalo, NY, United States of America
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Quantitative measurement of passive duction force tension in intermittent exotropia and its clinical implications. Graefes Arch Clin Exp Ophthalmol 2021; 259:1617-1623. [PMID: 33415355 DOI: 10.1007/s00417-020-05030-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the passive duction force (PDF) in extraocular muscles (EOMs) in patients with intermittent exotropia (IXT) using a quantitative tension-measuring device. METHODS This prospective, case-control study enrolled 25 patients with IXT and 26 age- and sex-matched controls. PDF was measured under general anesthesia as the eyeball was rotated medially or laterally away from the direction of the force being tested. The preferred eye for fixation was determined using a cover-uncover test. RESULTS The PDF in the IXT and control groups were 60.9 g and 52.1 g, respectively, for the lateral rectus (LR) (p = 0.046) and 53.0 g and 48.8 g for the medial rectus (MR) (p = 0.293). When the eyes were examined separately in the IXT group, the PDF of LR was larger in the nonpreferred eye for fixation than in the control group (p = 0.039), whereas there was no difference in the preferred eye for fixation (p = 0.216). Additionally, the relative PDF of LR in the nonpreferred eye compared to the ipsilateral PDF of MR was positively associated with the duration of manifest deviation (p = 0.042) and the average angle of the near and far deviations (p = 0.023). CONCLUSIONS The PDF in the LR in patients with IXT in the nonpreferred eye for fixation was larger than normal and could increase with the duration of manifest deviation and the angle of deviation. Evaluating the PDF in EOMs could provide information that is useful for managing strabismus and understanding its pathophysiology.
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