Ocular Torsion in Unilateral Superior Oblique Palsy

Na, Kyung Sun; Lee, Se Youp; Lee, Young Chun

doi:10.3341/jkos.2007.48.10.1388

Cited by 14 publications

(17 citation statements)

References 13 publications

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“…In previous literature, excyclotorsion of the paretic eye was documented in 61% to 75% of unilateral SOP, 16,23,24 which was higher than our observations. This discrepancy might result from the methodologic and/or etiologic differences in subjects among studies.…”

Section: Discussioncontrasting

confidence: 56%

“…This discrepancy might result from the methodologic and/or etiologic differences in subjects among studies. Na et al 16 included a relatively small number of acquired SOP subjects compared to congenital SOP and applied Bixenman and von Noorden's method 19 to estimate fundus torsion. Olivier and von Noorden 23 explored fundus torsion only in SOP subjects who had subjective torsion by the double Maddox rod test.…”

Section: Discussionmentioning

confidence: 99%

“…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 congenital SOP whose diagnosis was based on clinical grounds, and in a relatively small number of subjects.…”

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confidence: 99%

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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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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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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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“…The discrepancies among measurements of cyclodeviation have been well established. Na et al [3] reported that both excyclotorsion and hypertropia showed a significant and positive correlation with inferior oblique overaction (IOOA). Hypertropia and excyclotorsion showed a weaker positive correlation in congenital monocular SOP.…”

mentioning

confidence: 99%

“…Hypertropia and excyclotorsion showed a weaker positive correlation in congenital monocular SOP. However, Na et al [3]'s report included patient populations with congenital and acquired palsies.…”

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Relationship of Hypertropia and Excyclotorsion in Superior Oblique Palsy

Lee

Chun

Baek

et al. 2013

Korean J Ophthalmol

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PurposeTo evaluate the correlation between hypertropia and excyclotorsion in acquired superior oblique palsy (SOP).MethodsThirty-one patients with acquired unilateral SOP were recruited for this study. The torsional angle of each patient was assessed via one objective method (fundus photography) and two subjective methods (double Maddox rod test and major amblyoscope). The patient population was divided into two groups (concordance group, n = 19 and discordance group, n = 12) according to the correspondence between the hypertropic eye (paralytic eye) and the more extorted eye (non-fixating eye), which was evaluated by fundus photography.ResultsThe mean value of objective torsion was 5.09° ± 3.84°. The subjective excyclotorsion degrees were 5.18° ± 4.11° and 3.65° ± 1.93° as measured by double Maddox rod test and major amblyoscope, respectively. Hypertropia and the excyclotorsional angle did not differ significantly between the groups (p = 0.257). Although no correlation was found in the discordance group, the concordance group showed a significant and positive correlation between hypertropia and excyclotorsion (p = 0.011).ConclusionsTorsional deviation was not related to hypertropia. However, in the concordance patients in whom the hypertropic eye showed excyclotorsion, a significant positive correlation was found between hypertropia and excyclotorsion.

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