Measuring acquired ocular torsion with optical coherence tomography

Borgman, Christopher J; Haynes, Jessica A

doi:10.1111/cxo.13084

Cited by 3 publications

(7 citation statements)

References 9 publications

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“…Normal ocular torsion in optical coherence tomography has been reported to be −6.6°on average. 9 Note the increased excyclotorsion in the patient's right eye compared with the normal excyclotorsion in the left eye. Keane 6 reported that pontine lesions account for approximately 61% of skew deviations, whereas midbrain, medulla, and cerebellum lesions account for approximately 23%, 19%, and 0%, respectively.…”

Section: Discussionmentioning

confidence: 97%

“…Ocular torsion in skew deviation is reported to be 4° on average, with a range of −1 to −20° 7 . Recently, ocular torsion in skew deviation has also been objectively measured with optical coherence tomography 9 . Normal ocular torsion in optical coherence tomography has been reported to be −6.6° on average 9 …”

Section: Discussionmentioning

confidence: 99%

“…7 Recently, ocular torsion in skew deviation has also been objectively measured with optical coherence tomography. 9 Normal ocular torsion in optical coherence tomography has been reported to be −6.6°on average. 9 The posterior semicircular canal connects to the ipsilateral superior oblique and contralateral inferior rectus muscles for excitation.…”

Section: Discussionmentioning

confidence: 99%

“…9 Normal ocular torsion in optical coherence tomography has been reported to be −6.6°on average. 9 The posterior semicircular canal connects to the ipsilateral superior oblique and contralateral inferior rectus muscles for excitation. 1 The anterior semicircular canal connects to the ipsilateral superior rectus and contralateral inferior oblique muscles for excitation.…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Asymptomatic Skew Deviation Secondary to Chronic Ischemic Infarction of the Cerebellum

Borgman¹,

Krug²

2022

Optom Vis Sci

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SIGNIFICANCE: Skew deviation is likely encountered clinically more often than previously thought. Cerebellar causes of skew deviation appear to be the rarest cause and should be considered by clinicians when encountering patients with findings consistent with skew deviation. PURPOSE: This case report describes an undiagnosed, asymptomatic skew deviation in an established glaucoma patient returning for routine follow-up. Appropriate diagnosis and subsequent neuroimaging identified a chronic ischemic cerebellar infarction.CASE REPORT: A 72-year-old man presented for a routine glaucoma follow-up examination. Cover test revealed a 10-prism diopter left hypertropia, which worsened in right gaze and left head tilt. Double Maddox rod testing showed 5°excyclotorsion of the right eye and no torsion in the left eye. Upright-supine testing was positive. Given the patient's noticeable right head tilt, left hypertropia, increased excyclotorsion of his lower eye, and positive-upright test, the patient was diagnosed with a skew deviation. Brain MRI revealed a chronic, undiagnosed cerebellar ischemic infarction, a known cause of skew deviation and the associated ocular tilt reaction.CONCLUSIONS: It can be challenging to identify skew deviations and their underlying causes. When clinically encountering a vertical deviation, appropriate tests (cover-uncover test, Parks-Bielschowsky three-step test, ocular torsion testing, and upright-supine test) are imperative to help make the correct diagnosis. Neuroimaging can then be pursued in hopes of identifying the underlying cause.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Case Report: Asymptomatic Skew Deviation Secondary to Chronic Ischemic Infarction of the Cerebellum

Borgman¹,

Krug²

2022

Optom Vis Sci

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“…A more accurate numerical measurement most accepted by clinicians, the DFA, is defined as the angle between a horizontal line and a line drawn through the fovea and the center of the optic disc. The DFA can be measured using fundus photography (40,41), perimetry (42), scanning laser ophthalmoscopy (43), or optical coherence tomography (44,45). Anatomic variations of the DFA in normal subjects can range from −0.4 • to 12.76 • , with a mean of 6.39 • (2.72 • ), and the angle is typically slightly larger in the left than in the right eye (46).…”

Section: Discussionmentioning

confidence: 99%

A simple marking system for accurate intraoperative monitoring and adjustment of cyclotorsion strabismus surgery

et al. 2023

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Ocular cyclotorsion is treatable only with surgery. The surgical procedure must be tailored individually to the specific etiologies causing the horizontal and vertical strabismus and its torsional components. An adjustable surgical approach is often used for postoperative or intraoperative adjustments. However, the methods currently used have some limitations. In this study, we propose a simple intraoperative marking system for all cyclotorsion correction surgery. The proposed marking system used three sets of surface markers: external horizontal markings, ocular horizontal markings, and surgical torsion markings, drawn in sequence. We retrospectively analyzed the surgical results using this novel marking system in this single-center, single-surgeon study. Fifteen patients with cyclotorsion who underwent treatment using the proposed marking system as an intraoperative aid between August 2019 and August 2021 were included. The medical charts were thoroughly reviewed, and the pre-and postoperative subjective and objective cyclotorsion were analyzed. Among the study subjects (10 males, 5 females; age range: 6–89 years), 13 had excyclotorsion and 2 incyclotorsion. Preoperative mean net subjective cyclotorsion measured by the double Maddox rod (DMR) test was 6.0° (standard deviation: 10.8°) and mean net disc-to-fovea angle (DFA) was 20.23° (13.21°). The postoperative net DMR and DFA were 0.2° (2.1°) and 14.09° (5.97°), respectively. The mean absolute net DMR and DFA being treated were 9.8° (4.8°) and 9.76° (4.61°). Overall, the proposed intraoperative marking system is a simple and quantitative method to assess, monitor, and adjust the torsional aspect for all strabismus surgeries.

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The changes in ocular torsion after unilateral lateral rectus recession-medial rectus resection for intermittent exotropia

Liu,

Zhu

et al. 2024

Sci Rep

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We aim to explore the alterations of objective ocular torsion after unilateral lateral rectus recession-medial rectus resection (R&R) for intermittent exotropia (IXT). Seventy-two IXT patients undergoing R&R between March and June 2023 were enrolled. Ophthalmological examinations were performed before surgery and at 1 week and 1 month after surgery, mainly including prism and alternate cover test and optical coherence tomography. The mean disc-foveal angle of eyes showing intorsion significantly increased from − 1.5 ± 0.9° preoperatively to 2.0 ± 2.0° at 1 week (P = 0.0227) and 2.2 ± 1.6° at 1 month postoperatively (P = 0.0054). The mean disc-foveal angle of eyes exhibiting extorsion significantly reduced from 12.8 ± 1.9° preoperatively to 9.8 ± 3.1° at 1 week (P < 0.0001) and 9.7 ± 2.7° at 1 month postoperatively (P < 0.0001). The improvement of ocular extorsion at postoperative 1 month was more pronounced in patients with extorsion in operative eye compared to those with extorsion in inoperative eye (P = 0.0101). The improvement of ocular torsion was observed following R&R for IXT, with a greater effect noted in cases where the surgery was performed on the eye exhibiting extorsion.

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Measuring acquired ocular torsion with optical coherence tomography

Cited by 3 publications

References 9 publications

Case Report: Asymptomatic Skew Deviation Secondary to Chronic Ischemic Infarction of the Cerebellum

Case Report: Asymptomatic Skew Deviation Secondary to Chronic Ischemic Infarction of the Cerebellum

A simple marking system for accurate intraoperative monitoring and adjustment of cyclotorsion strabismus surgery

The changes in ocular torsion after unilateral lateral rectus recession-medial rectus resection for intermittent exotropia

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