Range of forced cyclorotation in superior oblique palsy and V-pattern strabismus
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PEDIATRICS
Range of forced cyclorotation in superior oblique palsy and V-pattern strabismus Seung Ah Chung 1
&
Seong Jung Ha 1 & Jae Ho Jung 2
Received: 14 July 2020 / Revised: 26 September 2020 / Accepted: 23 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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.
Key messages Forced duction test is an indispensable part of evaluating muscle tightness or laxity. Nevertheless, quantifying the range of forced duction remains challenging particularly in the torsional eye movement. We developed a simple quantitative torsional forced duction test using a smartphone application. .In addition to quantifying the passive range of cyclorotation in patients showing overelevation in adduction, we have shown that the range of excyclorotation had a strong positive correlation with the degree of rectus muscle e xcyclorotation in computed tomography scans. Although resistance to ocular torsion is primarily determined by oblique muscle tightness or laxity, our data indicate that the range of excyclorotation can also be affected by orbital alignments in these populations.
* Seung Ah Chung [email protected] 1
Department of Ophthalmology, Ajou University Hospital, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, South Korea
2
Department of Ophthalmology, Seoul National University Hospital, Seou
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