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Walton MMG. Disconjugacies of saccade duration and trajectories in strabismus. Strabismus 2024:1-19. [PMID: 39036886 DOI: 10.1080/09273972.2024.2378827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Introduction: For decades, the saccadic system has been a favorite target of neurophysiologists seeking to elucidate the neural control of eye movements, partly because saccades are characterized by a set of highly stereotyped relationships between amplitude, duration, and peak velocity. There is a large literature describing the dynamics and trajectories of these movements in normal primates, but there are no similarly detailed analyses for subjects with infantile strabismus syndrome. Previous studies have shown the amplitudes and directions of saccades often differ for the two eyes in this disorder, but it is unknown whether a similar disconjugacy exists for duration. The present study was designed to determine whether or not saccade duration differs for the two eyes in strabismus, and whether there are abnormalities involving the trajectories of these movements. Methods: Dynamic analyses of saccade trajectories and durations were performed for two normal monkeys, two with esotropia and two with exotropia. The amount of curvature was compared for the two eyes. For each monkey with strabismus, the amount of curvature was compared to normal controls. Saccades were placed into 12 bins, based on direction; for each bin, the mean saccade duration was compared for the two eyes (duration disconjugacy). The duration disconjugacy for each bin was then compared for monkeys with strabismus, versus normal control animals. Results: Surprisingly, the amount of curvature was not consistently greater in subjects with pattern strabismus. However, saccade curvature differed for the two eyes by a significantly greater amount for all monkeys with strabismus, compared to normal controls. In addition, for a subset of saccades in subjects with strabismus, saccade duration differed for the two eyes by more than 10 ms, even when the animal was fully alert. Discussion: To the best of the author's knowledge, this is the first study to show that, in strabismus, saccade durations can differ for the two eyes by an abnormally large amount. These data also suggest that, in monkeys with pattern strabismus, abnormal horizontal-vertical crosstalk in brainstem can lead to directional disconjugacy without significantly impairing component stretching. These results place important constraints on future attempts to model the neural mechanisms that contribute to directional disconjugacy in pattern strabismus.
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Affiliation(s)
- Mark M G Walton
- Washington National Primate Research Center, University of Washington, Seattle, WA, USA
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Liu C, Zhao Y, Liu J, Zhao Q. The causal effect of obesity on concomitant exotropia: A lifecourse Mendelian randomization study. Medicine (Baltimore) 2024; 103:e37348. [PMID: 38428888 PMCID: PMC10906616 DOI: 10.1097/md.0000000000037348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/02/2024] [Indexed: 03/03/2024] Open
Abstract
Obesity is now a significant global public health issue. Limited understanding exists regarding the association between obesity and concomitant exotropia. Our objective was to identify the causal relationship between lifecourse obesity, including birth weight, childhood body mass index (BMI), and adult BMI, and the risk of concomitant exotropia. We used a two-sample Mendelian randomization (MR) strategy to examine the causal relationship with inverse-variance weighted method as the primary MR analysis. We carried out sensitivity analyses to evaluate the accuracy and robustness of our findings. Also, we performed reverse-direction MR analysis to eliminate the possibility of reverse causality. Childhood BMI, as opposed to birth weight or adult BMI, had a significant impact on the risk of concomitant exotropia (odds ratio = 1.40, 95% confidence interval (CI): 1.08-1.81, P = .01). This significance persisted even after accounting for birth weight and adult BMI using multivariable MR analysis (odds ratio = 1.35, 95% CI: 1.04-1.75, P = .02). There was no significant heterogeneity or pleiotropy observed in sensitivity analyses (P > .05). Multivariable MR analysis further confirmed the absence of pleiotropic effects of some risk factors including prematurity, maternal smoking around birth and refractive error. Reverse causality did not affect the causal relationship (beta = -0.0244, 95% CI: -0.0545 to 0.0056, P = .11). Genetic predisposition to higher childhood BMI was found to be causally linked to an increased risk of concomitant exotropia.
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Affiliation(s)
- Changyang Liu
- Department of Ophthalmology, the Second Hospital of Dalian Medical University, Dalian, China
| | - Yaxin Zhao
- Department of Ophthalmology, the Second Hospital of Dalian Medical University, Dalian, China
| | - Jiasu Liu
- Department of Ophthalmology, the Second Hospital of Dalian Medical University, Dalian, China
| | - Qi Zhao
- Department of Ophthalmology, the Second Hospital of Dalian Medical University, Dalian, China
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Chen JY, Zhang LR, Liu JW, Hao J, Li HX, Zhang QY, Liu ZH, Fu J. Magnetic resonance imaging of extraocular rectus muscles abnormalities in acute acquired concomitant esotropia. Int J Ophthalmol 2024; 17:119-125. [PMID: 38239936 PMCID: PMC10754655 DOI: 10.18240/ijo.2024.01.16] [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: 01/30/2023] [Accepted: 10/20/2023] [Indexed: 01/22/2024] Open
Abstract
AIM To investigate the difference of medial rectus (MR) and lateral rectus (LR) between acute acquired concomitant esotropia (AACE) and the healthy controls (HCs) detected by magnetic resonance imaging (MRI). METHODS A case-control study. Eighteen subjects with AACE and eighteen HCs were enrolled. MRI scanning data were conducted in target-controlled central gaze with a 3-Tesla magnetic resonance scanner. Extraocular muscles (EOMs) were scanned in contiguous image planes 2-mm thick spanning the EOM origins to the globe equator. To form posterior partial volumes (PPVs), the LR and MR cross-sections in the image planes 8, 10, 12, and 14 mm posterior to the globe were summed and multiplied by the 2-mm slice thickness. The data were classified according to the right eye, left eye, dominant eye, and non-dominant eye, and the differences in mean cross-sectional area, maximum cross-sectional area, and PPVs of the MR and LR muscle in the AACE group and HCs group were compared under the above classifications respectively. RESULTS There were no significant differences between the two groups of demographic characteristics. The mean cross-sectional area of the LR muscle was significantly greater in the AACE group than that in the HCs group in the non-dominant eyes (P=0.028). The maximum cross-sectional area of the LR muscle both in the dominant and non-dominant eye of the AACE group was significantly greater than the HCs group (P=0.009, P=0.016). For the dominant eye, the PPVs of the LR muscle were significantly greater in the AACE than that in the HCs group (P=0.013), but not in the MR muscle (P=0.698). CONCLUSION The size and volume of muscles dominant eyes of AACE subjects change significantly to overcome binocular diplopia. The LR muscle become larger to compensate for the enhanced convergence in the AACE.
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Affiliation(s)
- Jia-Yu Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Capital Medical University, Beijing 100176, China
| | - Li-Rong Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Jia-Wen Liu
- Department of Industrial Engineering and Operation Research, University of California, Berkeley 94720, USA
| | - Jie Hao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Capital Medical University, Beijing 100176, China
| | - Hui-Xin Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Capital Medical University, Beijing 100176, China
| | - Qiong-Yue Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Capital Medical University, Beijing 100176, China
| | - Zhao-Hui Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Capital Medical University, Beijing 100176, China
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Shen T, Yang R, Kang Y, Ye Q, Wen Y, Wen F, Yan J. Inferior displacement of the lateral rectus muscle insertion in exotropia with mild V-pattern or vertical deviation. Graefes Arch Clin Exp Ophthalmol 2024; 262:267-279. [PMID: 37606824 DOI: 10.1007/s00417-023-06207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND To describe clinical features and intraoperative findings of the patients with exotropia who presented mild V-pattern or vertical deviation, and to investigate the surgical outcomes of anatomical relocation of inferiorly displaced lateral rectus (LR) muscle insertion. METHODS Detailed ophthalmological evaluations were obtained in 42 consecutive patients, and the horizontal rectus muscle insertions were detected intraoperatively. The displaced insertion of LR muscle was corrected accompanied with classic recession-resection procedure. RESULTS The inferiorly displaced LR muscle insertions were detected in 19 patients (Group A), while the remaining 23 patients (Group B) had normal insertions. The mean distance of displaced insertion from the normal position was 2.92 ± 1.05 mm (range: 1.0-4.0). Mild V-pattern was more common in Group A (78.9%, 15/19) than Group B (47.8%, 11/23), and the magnitude of V-pattern in Group A (6.16 ± 3.91 PD) was also greater than Group B (3.43 ± 3.92 PD). The fundus extorsions of the affected eyes (9.68 ± 4.77 °) were greater than the contralateral eyes (5.91 ± 5.82 °) in Group A. At the 2 months follow-up, mild V-pattern and mild vertical deviation were corrected by upward transposition. The significant correlations were identified between the pre-operative misalignments and the amounts of misalignments correction. CONCLUSIONS Nearly half of the cases with mild V-pattern or vertical deviation resulted from the inferiorly displaced LR muscle insertion, so the intraoperative exploration of the LR muscle insertion is strongly suggested. Upward transposition may effectively correct both the mild V-pattern and vertical deviation.
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Affiliation(s)
- Tao Shen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Ruijun Yang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Ying Kang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Qingqing Ye
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yun Wen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Jianhua Yan
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China.
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Hao R, Wang Y, Wang K, Wei A, Zhang W. A multimodal MRI study of functional and structural changes in concomitant exotropia. Exp Ther Med 2023; 26:442. [PMID: 37614419 PMCID: PMC10443055 DOI: 10.3892/etm.2023.12141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/19/2023] [Indexed: 08/25/2023] Open
Abstract
The present prospective study aimed to investigate the structural and functional changes in patients with concomitant exotropia using multimodal MRI. A total of 11 adult patients with concomitant exotropia (5 males and 6 females) and 11 healthy adult individuals (5 males and 6 females) were recruited and examined using multimodal MRI techniques. Near and distance exotropia deviation angles were measured. The structrual changes were evaluated using the gray matter volume. Functional reorganization was assessed using the amplitude of low-frequency fluctuation, regional homogeneity and resting-state functional connectivity (FC) on MRI. No significant differences could be found in terms of sex, age or body mass index between the two groups. However, the near and distance exotropia angles were significantly higer in the concomitant exotropia group compared with those in the normal control group (P<0.001). Compared with those in normal individuals, the bilateral thalamus, right middle temporal gyrus (MTG) and right cuneus had significantly reduced gray matter volumes in the concomitant exotropia group (false discovery rate corrected, P<0.05). Reduced FC was found between the bilateral thalamus and the bilateral precuneus, between the right MTG and the right medial superior frontal gyrus in addition to the right precuneus, and between the right cuneus and the right primary sensorimotor cortex (P<0.05, Gaussian random-field corrected) in the concomitant exotropia group compared with that in the normal individuals. In conclusion, the present study indicated that structural and functional reorganization occurs in specific brain regions of patients with concomitant exotropia. These reorganized areas appeared to mainly involve the subcortical structures and related cortices that process visual information.
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Affiliation(s)
- Rui Hao
- Department of Pediatric Ophthalmology and Strabismus, Tianjin Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Nankai University Affiliated Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin 300020, P.R. China
| | - Yang Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin Key Laboratory of Functional Imaging, Tianjin 300052, P.R. China
| | - Kailei Wang
- Department of Pediatric Ophthalmology and Strabismus, Tianjin Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Nankai University Affiliated Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin 300020, P.R. China
| | - Ang Wei
- Department of Ophthalmology, Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Nankai Hospital, Tianjin 300102, P.R. China
| | - Wei Zhang
- Department of Pediatric Ophthalmology and Strabismus, Tianjin Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Nankai University Affiliated Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin 300020, P.R. China
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Sunyer-Grau B, Quevedo L, Rodríguez-Vallejo M, Argilés M. Comitant strabismus etiology: extraocular muscle integrity and central nervous system involvement-a narrative review. Graefes Arch Clin Exp Ophthalmol 2023:10.1007/s00417-022-05935-9. [PMID: 36680614 DOI: 10.1007/s00417-022-05935-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/09/2022] [Accepted: 12/01/2022] [Indexed: 01/22/2023] Open
Abstract
Strabismus is not a condition in itself but the consequence of an underlying problem. Eye misalignment can be caused by disease, injury, and/or abnormalities in any of the structures and processes involved in visual perception and oculomotor control, from the extraocular muscles and their innervations to the oculomotor and visual processing areas in the brain. A small percentage of all strabismus cases are the consequence of well-described genetic syndromes, acquired insult, or disease affecting the extraocular muscles (EOMs) or their innervations. We will refer to them as strabismus of peripheral origin since their etiology lies in the peripheral nervous system. However, in most strabismus cases, that is comitant, non-restrictive, non-paralytic strabismus, the EOMs and their innervations function properly. These cases are not related to specific syndromes and their precise causes remain poorly understood. They are generally believed to be caused by deficits in the central neural pathways involved in visual perception and oculomotor control. Therefore, we will refer to them as central strabismus. The goal of this narrative review is to discuss the possible causes behind this particular type of eye misalignment and to raise awareness among eyecare professionals about the important role the central nervous system plays in strabismus etiology, and the subsequent implications regarding its treatment. A non-systematic search was conducted using PubMed, Medline, Cochrane, and Google Scholar databases with the keywords "origins," "causes," and "etiology" combined with "strabismus." A snowball approach was also used to find relevant references. In the following article, we will first describe EOM integrity in central strabismus; next, we will address numerous reasons that support the idea of central nervous system (CNS) involvement in the origin of the deviation, followed by listing several possible central causes of the ocular misalignment. Finally, we will discuss the implications CNS etiology has on strabismus treatment.
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Affiliation(s)
- Bernat Sunyer-Grau
- School of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Lluïsa Quevedo
- School of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa, Spain.
| | | | - Marc Argilés
- School of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa, Spain
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Gong W, Chen H, Yang F, Lin S, Li C, Wang G. Inter-eye Differences in Ocular Biometric Parameters of Concomitant Exotropia. Front Med (Lausanne) 2022; 8:724122. [PMID: 35059408 PMCID: PMC8763704 DOI: 10.3389/fmed.2021.724122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the ocular biometric parameters in patients with constant and intermittent exotropia by the measurement of swept-source optical coherence tomography (SS-OCT) optical biometer OA-2000 and comparing it with the normal control subjects. Design: Cross-sectional case-control study. Participants: Fifty-five constant and 24 intermittent patients with exotropia with central fixation and 77 orthotropic normal control participants aged 4-18 years old. Methods: Non-contact and high-resolution optical biometric OA-2000 measurements were conducted under uniform ambient light conditions. The statistical analysis included intraclass correlation coefficient (ICC), Bland-Altman plot, and independent t-tests. Main Outcome Measures: Spherical equivalent (SE), ocular biological parameters such as pupil diameter (PD), anterior chamber depth (ACD), lens thickness (LT), and axial lengths (AL). The absolute values of inter-eye differences for SE, PD, ACD, LT, and AL were recorded as AnisoSE, AnisoPD, AnisoACD, AnisoLT, and AnisoAL, respectively. Results: AnisoSE (0.878 vs. 0.577, P = 0.019), AnisoAL (0.395 vs. 0.208, P = 0.001), AnisoACD (0.060 vs. 0.032, P < 0.001), AnisoLT (0.060 vs. 0.031, P = 0.002), and AnisoPD (0.557 vs. 0.340, P = 0.002) were significantly larger in concomitant patients with exotropia. The SE, AL, ACD, LT, and PD showed excellent binocular correlation with ICC values that ranged from 0.943 to 0.987 in control participants and from 0.767 to 0.955 in concomitant exotropia patients. Bland-Altman plots showed the wider range of agreement in patients with concomitant exotropia than the control participants (SE: 5.0288 vs. 3.3258; AL: 2.2146 vs. 1.3172; ACD:0.3243 vs. 0.1682; PD: 2.4691 vs. 1.9241; and LT:0.3723 vs 0.1858). Conclusion: Patients with concomitant exotropia showed larger inter-eye differences in SE, ACD, LT, PD, and AL. Advice should be given to suspicious children to avoid or delay the development of concomitant exotropia.
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Affiliation(s)
- Weifen Gong
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | | | | | | | | | - Geng Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
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High Level of Inflammatory Cytokines in the Tears: A Bridge of Patients with Concomitant Exotropia and Dry Eye. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5662550. [PMID: 34659636 PMCID: PMC8516558 DOI: 10.1155/2021/5662550] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/05/2021] [Accepted: 09/18/2021] [Indexed: 11/18/2022]
Abstract
Concomitant exotropia have obvious symptoms of eye discomfort in adults, and the presence of ocular surface inflammation in patients may be important mediators between concomitant exotropia and dry eye. Oculus Keratograph eye comprehensive analyzer was performed to detect noninvasive tear break time, noninvasive tear height, and eye red index, while the ocular surface disease index and schirmer I testing were made. The levels of IL-6, IL-10, IL-17A, IL-12P70, INF-γ, and TNF-α were detected in tears in patients with concomitant exotropia and healthy controls matched by age and gender through the Simoa technology. IL-6 was significantly higher in patients with concomitant exotropia (4.683 ± 1.329) pg/mL than that in normal group (1.455 ± 0.391) pg/mL, p = 0.0304. TNF-α was also significantly higher in patients (0.2095 ± 0.0703) pg/mL than normal group (0.0513 ± 0.0149) pg/mL, p = 0.0397. The levels of inflammatory factors in strabismic patients vs. normal controls were as follows: IL-17A (0.1551 pg/mL︰0.0793 pg/mL), IL-10 (0.3358 pg/mL︰0.0513 pg/mL), IL-12p70 (0.0253 pg/mL︰0.0099 pg/mL), and INF-γ (0.0284 pg/mL︰0.009 pg/mL) were detected, and the median of them in concomitant strabismus was 1.96-6.55-fold as much as the control group. High levels of inflammatory cytokines in tears of patients with concomitant exotropia, which may be a potentially factor promoted the occurrence of dry eye in the patients with concomitant exotropia.
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Range of forced cyclorotation in superior oblique palsy and V-pattern strabismus. Graefes Arch Clin Exp Ophthalmol 2020; 259:1035-1043. [PMID: 33128673 DOI: 10.1007/s00417-020-04994-0] [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: 07/14/2020] [Revised: 09/26/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To quantify a passive range of cyclorotation using a smartphone application and evaluate its associations with fundus torsion and rectus muscle cyclorotation in superior oblique palsy (SOP) and V-pattern strabismus. METHODS Fifty-two patients showing overelevation in adduction (30 with congenital SOP and 22 with V-pattern strabismus) underwent forced cyclorotation on the photographs. A photograph of the globe was taken in maximally excyclorotated and incyclorotated positions after marking at the 6 and 12 o'clock limbus under general anaesthesia, and the rotational alignment of these markings was read using the toriCAM application. The degrees of forced cyclorotation were compared between the two groups. Disc-fovea angle on fundus photographs and rectus muscle cyclorotation in the coronal view on orbital computed tomography were correlated with the range of forced excyclorotation. RESULTS The range of forced excyclorotation was greater in V-pattern strabismus than that in SOP (58.5° vs. 46.8°, p < 0.001), whereas the ranges of incyclorotation were similar between the two groups (39.0° vs. 39.0°, p = 0.543). Regression analysis revealed a significant increase in the range of excyclorotation with the degree of rectus muscle excyclorotation, after accounting for age and angle of hypertropia (r2 = 0.475, p = 0.001). The range of excyclorotation did not correlate with the amount of fundus extorsion and grade of overelevation in adduction. CONCLUSIONS The range of excyclorotation was correlated with the rectus muscle excyclorotation in these populations, suggesting that the results from this forced cyclorotation test may reflect orbital alignment and oblique muscle status.
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Sieck EG, Madabhushi A, Patnaik JL, Jung JL, Lynch AM, Singh JK. Comparison of Different Surgical Approaches to Inferior Oblique Overaction. J Binocul Vis Ocul Motil 2020; 70:89-93. [PMID: 32511077 DOI: 10.1080/2576117x.2020.1776566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The purpose of this study is to compare surgical outcomes of recession, anteriorization, and myotomy for the treatment of inferior oblique overaction (IOOA). METHODS A retrospective chart review of all patients undergoing IOOA correction from July 2010 to March 2017 at the Children's Hospital of Colorado was performed. Preoperative grading of IOOA (+0.5 to +4.0) was compared to post-operative IOOA (0 to +4.0). The goal was reduction of IOOA to 0, but any decrease in IOOA was measured. RESULTS There were a total of 260 patients with 357 eyes. Gender and age were similar across surgery types. A 94.6% of eyes had a decrease in IOOA with recession (n = 165) of the inferior oblique while 86.1% decreased to no IOOA. Anteriorization of the inferior oblique (n = 115) decreased overaction in 97.4% of eyes with 81.7% improving to zero degree of IOOA. Myotomy of the inferior oblique (n = 77) was found to decrease overaction in 98.7% of eyes and reduce IOOA to zero in 88.3%. There was no significant difference among type of surgery and outcome. CONCLUSION All three surgical interventions were found to be equally successful in reducing the amount of IOOA.
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Affiliation(s)
- Erin G Sieck
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, Colorado
| | - Anirudh Madabhushi
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, Colorado
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, Colorado
| | - Jennifer L Jung
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, Colorado
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, Colorado
| | - Jasleen K Singh
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, Colorado
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Kinori M, Pansara M, Mai DD, Robbins SL, Hesselink JR, Granet DB. Inferior rectus displacement in heavy eye syndrome and sagging eye syndrome. Graefes Arch Clin Exp Ophthalmol 2020; 258:1109-1113. [PMID: 32095879 DOI: 10.1007/s00417-020-04629-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/08/2020] [Accepted: 02/13/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate if there is a nasal displacement of the vertical rectus muscles in heavy eye syndrome (HES) and/or sagging eye syndrome (SES) compared with age-matched controls. METHODS We reviewed the charts of all patients with the diagnosis of HES or SES who were seen at the University of California San Diego (UCSD) between the years 2008-2016 who underwent magnetic resonance imaging (MRI) of the brain and orbits. The control group included patients who had brain and orbital MRIs at UCSD in the absence of known pathology in the orbits or globes. Measurements were taken by 3 separate examiners for all groups. RESULTS Twenty-four patients (16 with SES and 8 with HES) and 24 age-matched controls were retrospectively reviewed. The superior rectus (SR) of patients with HES and SES was more nasally displaced from the midline compared with that of age-matched controls (p = 0.04, p = 0.03, respectively). The inferior rectus (IR) of patients with HES but not with SES was more nasally displaced from the midline compared with that of age-matched controls (p = 0.04, p = 0.62, respectively). In all groups, the IR nasal displacement from the midline was approximately double compared with the SR. CONCLUSIONS There is a significant nasal displacement of the SR in HES and SES and IR in HES. The observed IR nasal displacement in HES is a new finding and may explain the residual hypotropia and/or esotropia following surgical interventions for HES not involving the IR.
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Affiliation(s)
- Michael Kinori
- Ratner Children's Eye Center at the Shiley Eye Institute, University of California, San Diego, 9415 Campus Point Drive, La Jolla, San Diego, CA, 92093, USA
- The Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Megha Pansara
- Ratner Children's Eye Center at the Shiley Eye Institute, University of California, San Diego, 9415 Campus Point Drive, La Jolla, San Diego, CA, 92093, USA
| | - Derek D Mai
- Ratner Children's Eye Center at the Shiley Eye Institute, University of California, San Diego, 9415 Campus Point Drive, La Jolla, San Diego, CA, 92093, USA
| | - Shira L Robbins
- Ratner Children's Eye Center at the Shiley Eye Institute, University of California, San Diego, 9415 Campus Point Drive, La Jolla, San Diego, CA, 92093, USA
| | - John R Hesselink
- Department of Radiology, University of California, San Diego, USA
| | - David B Granet
- Ratner Children's Eye Center at the Shiley Eye Institute, University of California, San Diego, 9415 Campus Point Drive, La Jolla, San Diego, CA, 92093, USA.
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12
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Tibrewal S, Sharma M, Rath S, Ganesh S. Extra-large V pattern in exotropia: a rare case and its management. Strabismus 2020; 28:91-96. [DOI: 10.1080/09273972.2020.1714670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Shailja Tibrewal
- Department of Pediatric Ophthalmology and Strabismus, Dr Shroff Charity Eye Hospital, New Delhi
| | - Manasvini Sharma
- Department of Pediatric Ophthalmology and Strabismus, Dr Shroff Charity Eye Hospital, New Delhi
| | - Soveeta Rath
- Department of Pediatric Ophthalmology and Strabismus, Dr Shroff Charity Eye Hospital, New Delhi
| | - Suma Ganesh
- Department of Pediatric Ophthalmology and Strabismus, Dr Shroff Charity Eye Hospital, New Delhi
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13
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Wang X, Zhang W, Liu L. Effect of Isolated Oblique Muscle Weakening Procedures on Horizontal Deviation in A- and V-pattern Exotropia. Curr Eye Res 2019; 45:211-214. [PMID: 31461370 DOI: 10.1080/02713683.2019.1660795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose: To evaluate the effect of isolated oblique muscle weakening on horizontal deviation in patients with A- and V-pattern exotropia.Methods: The medical records of patients who underwent bilateral oblique muscle weakening for A- and V-pattern exotropia associated oblique muscle overaction between 2011 and 2018 were reviewed. The primary outcome measures were the angle of horizontal deviation and the amount of pattern collapse.Results: Forty-three patients had A-pattern exotropia with bilateral superior oblique muscle overaction (SOOA) and underwent superior oblique (SO) weakening, while 44 patients had V-pattern exotropia with inferior oblique muscle overaction (IOOA) and underwent inferior oblique (IO) weakening. There were significant differences in exodeviation at near and distance between measurements obtained before and after oblique muscle weakening procedures (p < .05). The mean horizontal esoshift at distance was 7.9 PD in patients who underwent SO weakening and 9.5 PD in patients who underwent IO weakening. The mean postoperative collapse was 24.6 PD for A-pattern and 10.1 PD for V-pattern exotropia.Conclusion: The oblique muscle weakening procedures have secondary effects and reduce horizontal exodeviation. This study suggests that surgeons should be aware of the effects of oblique muscle weakening on horizontal deviation and pattern collapse of when planning and performing strabismus surgery.
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Affiliation(s)
- Xi Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenqiu Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Longqian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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14
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Kennedy TA, Corey AS, Policeni B, Agarwal V, Burns J, Harvey HB, Hoang J, Hunt CH, Juliano AF, Mack W, Moonis G, Murad GJ, Pannell JS, Parsons MS, Powers WJ, Schroeder JW, Setzen G, Whitehead MT, Bykowski J. ACR Appropriateness Criteria® Orbits Vision and Visual Loss. J Am Coll Radiol 2018; 15:S116-S131. [PMID: 29724415 DOI: 10.1016/j.jacr.2018.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 01/22/2023]
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15
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Normal Topography and Binocularity of the Superior Colliculus in Strabismus. J Neurosci 2017; 38:173-182. [PMID: 29133438 DOI: 10.1523/jneurosci.2589-17.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/30/2017] [Accepted: 11/08/2017] [Indexed: 02/03/2023] Open
Abstract
In subjects with alternating strabismus, either eye can be used to saccade to visual targets. The brain must calculate the correct vector for each saccade, which will depend on the eye chosen to make it. The superior colliculus, a major midbrain center for saccade generation, was examined to determine whether the maps serving each eye were shifted to compensate for strabismus. Alternating exotropia was induced in two male macaques at age 1 month by sectioning the tendons of the medial recti. Once the animals grew to maturity, they were trained to fixate targets with either eye. Receptive fields were mapped in the superior colliculus using a sparse noise stimulus while the monkeys alternated fixation. For some neurons, sparse noise was presented dichoptically to probe for anomalous retinal correspondence. After recordings, microstimulation was applied to compare sensory and motor maps. The data showed that receptive fields were offset in position by the ocular deviation, but otherwise remained aligned. In one animal, the left eye's coordinates were rotated ∼20° clockwise with respect to those of the right eye. This was explained by a corresponding cyclorotation of the ocular fundi, which produced an A-pattern deviation. Microstimulation drove the eyes accurately to the site of receptive fields, as in normal animals. Single-cell recordings uncovered no evidence for anomalous retinal correspondence. Despite strabismus, neurons remained responsive to stimulation of either eye. Misalignment of the eyes early in life does not alter the organization of topographic maps or disrupt binocular convergence in the superior colliculus.SIGNIFICANCE STATEMENT Patients with strabismus are able to make rapid eye movements, known as saccades, toward visual targets almost as gracefully as subjects with normal binocular alignment. They can even exercise the option of using the right eye or the left eye. It is unknown how the brain measures the degree of ocular misalignment and uses it to compute the appropriate saccade for either eye. The obvious place to investigate is the superior colliculus, a midbrain oculomotor center responsible for the generation of saccades. Here, we report the first experiments in the superior colliculus of awake primates with strabismus using a combination of single-cell recordings and microstimulation to explore the organization of its topographic maps.
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16
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Adams DL, Economides JR, Horton JC. Incomitance and Eye Dominance in Intermittent Exotropia. Invest Ophthalmol Vis Sci 2017; 58:4049-4055. [PMID: 28813578 PMCID: PMC5559177 DOI: 10.1167/iovs.17-22155] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine if the deviation angle changes in subjects with intermittent exotropia as they alternate fixation between the right and left eye in primary gaze. Methods In this prospective observational cohort study, 37 subjects with intermittent exotropia were tested for evidence of incomitance. The position of each eye was recorded with a video tracker during fixation on a small central target. A cover-uncover test was performed by occluding one eye with a shutter that passed infrared light, allowing continuous tracking of both eyes. The deviation angle was measured during periods of right eye and left eye fixation. Incomitance was assessed as a function of eye preference, fixation stability, and exotropia variability. Results The mean exotropia was 18.2° ± 8.1°. A difference between right exotropia and left exotropia was detectable in 16/37 subjects. Allowing for potential tracking error, the incomitance had a mean amplitude of 1.7°. It was not related to a difference in accommodative effort, eye preference, fixation stability, or variability in deviation. Conclusions Comitance is regarded as a feature that distinguishes strabismus from paralytic or restrictive processes. Unexpectedly, eye tracking during the cover-uncover test showed that incomitance is present in approximately 40% of subjects with intermittent exotropia. It averages 10% of the exotropia, and can equal up to 5°. When substantial, it may be worth considering when planning surgical correction.
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Affiliation(s)
- Daniel L Adams
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States.,Center for Mind/Brain Sciences, The University of Trento, Trento, Italy
| | - John R Economides
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | - Jonathan C Horton
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
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17
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Abstract
PURPOSE OF REVIEW To review the most recent literature regarding the clinical experience of imaging modalities in strabismus. RECENT FINDINGS MRI of extraocular muscles (EOMs) has elucidated the roles of variation in compartmental contraction of EOMs and further evidence of EOM pulley heterotopy in various strabismus patterns, which may contribute to the clinical and surgical management of patients as this mode of imaging becomes more readily available. Ultrasound biomicroscopy (UBM) and anterior-segment optical coherence tomography (AS-OCT) may play a role in determining the location of EOMs which could also aid in devising a preoperative surgical plan, especially in those who have had prior strabismus surgery. SUMMARY Although MRI, UBM, and AS-OCT show promise in the formulation of a treatment plan in complex strabismus, more research regarding the role and limitations of these imaging modalities is required before they become the mainstay of strabismus evaluation.
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18
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Walton MMG, Pallus A, Fleuriet J, Mustari MJ, Tarczy-Hornoch K. Neural mechanisms of oculomotor abnormalities in the infantile strabismus syndrome. J Neurophysiol 2017; 118:280-299. [PMID: 28404829 DOI: 10.1152/jn.00934.2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 02/08/2023] Open
Abstract
Infantile strabismus is characterized by numerous visual and oculomotor abnormalities. Recently nonhuman primate models of infantile strabismus have been established, with characteristics that closely match those observed in human patients. This has made it possible to study the neural basis for visual and oculomotor symptoms in infantile strabismus. In this review, we consider the available evidence for neural abnormalities in structures related to oculomotor pathways ranging from visual cortex to oculomotor nuclei. These studies provide compelling evidence that a disturbance of binocular vision during a sensitive period early in life, whatever the cause, results in a cascade of abnormalities through numerous brain areas involved in visual functions and eye movements.
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Affiliation(s)
- Mark M G Walton
- Washington National Primate Research Center, University of Washington, Seattle, Washington;
| | - Adam Pallus
- Washington National Primate Research Center, University of Washington, Seattle, Washington.,Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Jérome Fleuriet
- Washington National Primate Research Center, University of Washington, Seattle, Washington.,Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Michael J Mustari
- Washington National Primate Research Center, University of Washington, Seattle, Washington.,Department of Ophthalmology, University of Washington, Seattle, Washington.,Department of Biological Structure, University of Washington, Seattle, Washington; and
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, Washington.,Seattle Children's Hospital, Seattle, Washington
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19
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Economides JR, Adams DL, Horton JC. Normal correspondence of tectal maps for saccadic eye movements in strabismus. J Neurophysiol 2016; 116:2541-2549. [PMID: 27605534 DOI: 10.1152/jn.00553.2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/06/2016] [Indexed: 11/22/2022] Open
Abstract
The superior colliculus is a major brain stem structure for the production of saccadic eye movements. Electrical stimulation at any given point in the motor map generates saccades of defined amplitude and direction. It is unknown how this saccade map is affected by strabismus. Three macaques were raised with exotropia, an outwards ocular deviation, by detaching the medial rectus tendon in each eye at age 1 mo. The animals were able to make saccades to targets with either eye and appeared to alternate fixation freely. To probe the organization of the superior colliculus, microstimulation was applied at multiple sites, with the animals either free-viewing or fixating a target. On average, microstimulation drove nearly conjugate saccades, similar in both amplitude and direction but separated by the ocular deviation. Two monkeys showed a pattern deviation, characterized by a systematic change in the relative position of the two eyes with certain changes in gaze angle. These animals' saccades were slightly different for the right eye and left eye in their amplitude or direction. The differences were consistent with the animals' underlying pattern deviation, measured during static fixation and smooth pursuit. The tectal map for saccade generation appears to be normal in strabismus, but saccades may be affected by changes in the strabismic deviation that occur with different gaze angles.
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Affiliation(s)
- John R Economides
- Beckman Vision Center, Program in Neuroscience, University of California, San Francisco, California; and
| | - Daniel L Adams
- Beckman Vision Center, Program in Neuroscience, University of California, San Francisco, California; and.,Center for Mind/Brain Sciences, The University of Trento, Trento, Italy
| | - Jonathan C Horton
- Beckman Vision Center, Program in Neuroscience, University of California, San Francisco, California; and
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