Morphometry of the Trochlear Nerve and Superior Oblique Muscle Volume in Congenital Superior Oblique Palsy

Lee, Dae Seung; Yang, Hee Kyung; Kim, Jae Hyoung; Hwang, Jeong‐Min

doi:10.1167/iovs.14-15323

Cited by 16 publications

(13 citation statements)

References 17 publications

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“…In the two most recent studies [2,3] Yang et al presented further evidence that there are two different pathogenic mechanisms for congenital oblique palsies. Those diagnosed with unilateral congenital oblique palsies with an absent trochlear nerve had a significantly different correlation of the size of the trochlear nerve and the volume of the superior oblique tendon and muscle, even on the nonparetic side, compared with patients who had unilateral superior oblique palsies in which both trochlear nerves were present, and with control subjects without a superior oblique palsy.…”

Section: High-definition Mri Studiesmentioning

confidence: 99%

“…Yang, Kim, Hwang, and Lee's work [1][2][3] with highresolution MRI scans on children diagnosed with congenital superior oblique paralysis has advanced our understanding of the pathophysiology of this common entity considerably. They were able to image not only the superior oblique muscle, but also for the first time to consistently image the trochlear nerve itself.…”

Section: High-definition Mri Studiesmentioning

confidence: 99%

“…They were able to image not only the superior oblique muscle, but also for the first time to consistently image the trochlear nerve itself. Yang, Kim, Hwang, and Lee published their results in several studies [1][2][3], all based on 125 consecutive patients identified with unilateral congenital superior oblique palsy at a tertiary care medical center. All 125 patients were invited to undergo high-resolution MRI.…”

Section: High-definition Mri Studiesmentioning

confidence: 99%

“…High-definition MRI studies [1][2][3] also provide some evidence (though not definitive) that torticollis may be progressive if not corrected. Yang et al [1] found that although the majority of patients in both the trochlear absence and trochlear present groups developed a head tilt (95.8 and 80.8%, respectively), the head tilt was present much earlier in the trochlear absence group, with 80.0% in the trochlear absence group having a head tilt by the age of 1 year compared with only 29.4% of the trochlear present group.…”

Section: Indications and Timing Of Surgerymentioning

confidence: 99%

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Treatment and diagnosis of congenital fourth nerve palsies

Engel¹

2015

Current Opinion in Ophthalmology

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Section: High-definition Mri Studiesmentioning

confidence: 99%

Section: High-definition Mri Studiesmentioning

confidence: 99%

Section: High-definition Mri Studiesmentioning

confidence: 99%

Section: Indications and Timing Of Surgerymentioning

confidence: 99%

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Treatment and diagnosis of congenital fourth nerve palsies

Engel¹

2015

Current Opinion in Ophthalmology

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“…5,6,10,21,22 Children younger than 6 years were sedated by chloral hydrate. We measured the areas of the SO manually using Picture Archiving and Communication System (PACS) software (INFINITT, Seoul, Korea), which provides automatic acquisition for area.…”

Section: Magnetic Resonance Imaging: Trochlear Nerve and Superior Oblmentioning

confidence: 99%

Ocular Torsion According to Trochlear Nerve Absence in Unilateral Superior Oblique Palsy

Lee

Yang

Kim

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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Citation: Lee JE, Yang HK, Kim JH, Hwang J-M. Ocular torsion according to trochlear nerve absence in unilateral superior oblique palsy. Invest Ophthalmol Vis Sci. 2017;58:5526-5531. DOI:10.1167/iovs.17-22452 PURPOSE. To investigate the relationship between objective ocular torsion and the presence or absence of the trochlear nerve in subjects with unilateral superior oblique palsy (SOP). METHODS.A total of 159 subjects with congenital and acquired unilateral SOP were reviewed. Eighty-four subjects who had a normal trochlear nerve (present group) and 75 subjects without a trochlear nerve (absent group) were included. Cyclovertical motility parameters and objective ocular torsion were compared between groups, and factors related to ocular torsion were evaluated. RESULTS.The degree of ''net'' excyclotorsion in the paretic eye was larger in the absent group compared to the present group (P ¼ 0.002). The proportion of net excyclotorsion in the paretic eye was greater in the absent group (11% vs. 37%), while net incyclotorsion was greater in the present group (41% vs. 23%) (P < 0.001). Net excyclotorsion of the paretic eye was associated with absence of the trochlear nerve (P < 0.001) and smaller size of the paretic SO (P < 0.001). Net incyclotorsion of the paretic eye was related with a normal trochlear nerve (P ¼ 0.005), larger size of the paretic SO (P ¼ 0.002), and greater hypertropia during ipsilateral gaze (P ¼ 0.024).CONCLUSIONS. The status of the trochlear nerve, paretic SO size, and hypertropia during ipsilateral gaze which reflects the tensile strength of the ipsilateral superior rectus, significantly contribute to ocular torsion in unilateral SOP.Keywords: superior oblique palsy, trochlear nerve, ocular torsion R ecent investigations based on advanced imaging modalities and functional anatomy have offered novel approaches to understand the etiology and pathophysiology of superior oblique palsy (SOP).1-11 Absence of the trochlear nerve has been well recognized as one of the major pathologic etiologies of SOP. 5,6,10 In our earlier study of congenital SOP, 73% showed ipsilateral trochlear nerve absence and a variable extent of SO hypoplasia, whereas the remainder had a normal-appearing SO and trochlear nerve on both sides. 10The relevance of ocular torsion in the diagnosis of SOP is well recognized.12,13 Identification of bilateral excyclotorsion provides essential information in diagnosing bilateral SOP, 14 and incyclotorsion of the hypertropic eye suggests skew deviation. 15 However, torsional patterns in unilateral SOP have shown inconsistent results, and little is known about the torsional changes in SOP according to its pathogenic etiology. To date, there are only few studies 10,11,16 investigating subjective and objective torsion in SOP according to its major etiologies. In our previous report, 10 objective ocular torsion using fundus photographs with an internal fixator did not show any differences according to the presence of the trochlear nerve; however, the investigation was conducted only in con...

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Eye Movement Disorders

Tamhankar¹

2019

Liu, Volpe, and Galetta's Neuro-Ophthalmology

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Morphometry of the Trochlear Nerve and Superior Oblique Muscle Volume in Congenital Superior Oblique Palsy

Cited by 16 publications

References 17 publications

Treatment and diagnosis of congenital fourth nerve palsies

Treatment and diagnosis of congenital fourth nerve palsies

Ocular Torsion According to Trochlear Nerve Absence in Unilateral Superior Oblique Palsy

Eye Movement Disorders

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