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Journal of AAPOS : the Official... Dec 2023Patients with highly myopic strabismus generally develop esotropia and hypotropia. We report the case of a 54-year-old woman with a combination of esotropia-hypertropia...
Patients with highly myopic strabismus generally develop esotropia and hypotropia. We report the case of a 54-year-old woman with a combination of esotropia-hypertropia complex in the right eye and esotropia-hypotropia complex in the left eye, with unilateral congenital severe ptosis. The patient had inferotemporal prolapse of the globe in the right eye. Inferotemporal prolapse in this case could have been due to extraocular muscle pulley dehiscence in this area, causing the inferior oblique muscle to slip around the globe along the path of least resistance. Subsequently, the inferotemporal staphyloma would have prevented the typical esotropia and hypotropia of the globe.
Topics: Female; Humans; Middle Aged; Esotropia; Ophthalmologic Surgical Procedures; Magnetic Resonance Imaging; Strabismus; Myopia; Oculomotor Muscles; Prolapse
PubMed: 37777052
DOI: 10.1016/j.jaapos.2023.08.008 -
Journal of Pediatric Ophthalmology and... Jan 2018
Topics: Eye Movements; Humans; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Strabismus; Treatment Outcome
PubMed: 29378079
DOI: 10.3928/01913913-20171212-01 -
Journal of AAPOS : the Official... Dec 2018To describe the prevalence and clinical features of a common but underrecognized disorder of adult vertical strabismus.
PURPOSE
To describe the prevalence and clinical features of a common but underrecognized disorder of adult vertical strabismus.
METHODS
The medical records of all adult (≥19 years of age) residents of Olmsted County, Minnesota, diagnosed with nonparalytic, small-angle hypertropia (NPSAH) from January 1, 1985, through December 31, 2004, were retrospectively reviewed for demographic and clinical features.
RESULTS
Of 753 patients diagnosed with adult-onset strabismus, 99 (13.1%) were found to have NPSAH, yielding an annual incidence of 7.50 per 100,000 patients >18 years of age and a cumulative incidence of 1.28%. The median age at diagnosis was 71 years (range, 27-98 years); 63 (64%) were women. Diplopia was reported at the initial diagnosis in 91 patients (93.8%), with 90 (92.8%) having the diplopia in primary or reading position. The median initial angle of hypertropia was 2 (range, 1-22) at near and 2 (range, 0-12) at distance. After a median follow-up of 10.8 years (range, 6.2 months to 23.7 years), the final median angle of vertical deviation was 4 (range, 0-20) at near and 4 (range, 0-16) at distance for all 99 patients.
CONCLUSIONS
NPSAH is a relatively common but infrequently recognized disorder among adults. More prevalent among elderly and female patients in this study cohort, the vast majority presented with diplopia and a hypertropia of ≤10 that progressed over time.
Topics: Adult; Age Distribution; Age of Onset; Aged; Aged, 80 and over; Disease Progression; Eye Movements; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Minnesota; Oculomotor Muscles; Prevalence; Retrospective Studies; Risk Factors; Sex Distribution; Strabismus; Time Factors; Visual Acuity
PubMed: 30321668
DOI: 10.1016/j.jaapos.2018.07.348 -
Southern Medical Journal Aug 1961
Topics: Humans; Strabismus
PubMed: 13744524
DOI: 10.1097/00007611-196108000-00015 -
Journal of AAPOS : the Official... Jun 2014To evaluate the incidence and features of hypertropia in abducens nerve palsy.
PURPOSE
To evaluate the incidence and features of hypertropia in abducens nerve palsy.
METHODS
The records of consecutive patients with unilateral, isolated, previously unoperated abducens nerve palsy were reviewed for binocular alignment on cover testing, Krimsky measurement, or Hess screen testing. Patients with associated cranial nerve palsy (including bilateral abducens palsies), orbital disease, myasthenia gravis, Horner syndrome, hemiplegia, cerebellar signs, arteritis, or previous strabismus surgery were excluded. Control subjects underwent complete examination to confirm normality.
RESULTS
A total of 79 patients were included (40 males; mean age 49.2 years). Hypertropia in lateral or central gazes was present in 15 of 79 cases (19%) on alternate cover or Krimsky testing, in 32 of 56 cases (57%) on Hess screen testing, and absent in all 30 normal controls. Of cases with hypertropia, the mean of the greatest hypertropia in lateral or central gaze on was 5.0(Δ) ± 2.3(Δ) (standard deviation; range, 1(Δ)-8(Δ)) routine clinical examination, and 5.8(Δ) ± 4.2(Δ) (range, 2(Δ)-24(Δ)) on Hess screen testing. Of 39 cases with partial abducens palsy evaluated by Hess screen testing, the ipsilesional eye was hypertropic in 24 (61%) and hypotropic in 15 cases (39%).
CONCLUSIONS
Small-angle hypertropia is common in isolated, unilateral abducens and does not imply existence of multiple cranial neuropathies or skew deviation.
Topics: Abducens Nerve Diseases; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Eye Movements; Female; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Middle Aged; Oculomotor Muscles; Retrospective Studies; Strabismus; Tomography, X-Ray Computed; Young Adult
PubMed: 24924275
DOI: 10.1016/j.jaapos.2014.01.017 -
Journal of AAPOS : the Official... Oct 2021To assess the outcomes of superior rectus-weakening surgery in patients with thyroid-associated ophthalmopathy (TAO).
PURPOSE
To assess the outcomes of superior rectus-weakening surgery in patients with thyroid-associated ophthalmopathy (TAO).
METHODS
The medical records of patients with TAO who were treated with surgical weakening of the superior rectus muscle at the Zhongshan Ophthalmic Center from 2008 to 2018 were reviewed retrospectively. Data collected included sex, age at surgery, duration of deviation, ocular alignment, ocular motility, surgical procedures, and outcomes. Surgical success was defined as the absence of diplopia and a vertical deviation of ≤5 in primary and reading positions.
RESULTS
A total of 33 patients (mean age 45.7 years; 17 males) were included. Of the 33 patients, 28 received unilateral superior rectus recession, with a success rate for primary surgery of 79%. The mean preoperative hypertropia of 35.1 ± 19.3 was significantly reduced to 3.9 ± 9.7. Ocular infraduction restriction significantly improved from a preoperative average of -5.3 ± 1.9 to -1.3 ± 1.3 postoperatively. Five patients underwent superior rectus tenotomy, with only 2 cases having a successful final outcome. For 27 of 33 cases, only a single surgery was required; 6 cases required a second surgery. The overall final success rate was 76%.
CONCLUSIONS
In our study cohort, superior rectus recession with or without traction suture for hypertropia in thyroid-associated ophthalmopathy resulted in a high rate of success.
Topics: Graves Ophthalmopathy; Humans; Male; Middle Aged; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Retrospective Studies; Strabismus; Treatment Outcome
PubMed: 34563695
DOI: 10.1016/j.jaapos.2021.05.010 -
Journal of Binocular Vision and Ocular... 2022Inferior oblique muscle overaction (IOOA) is an ocular motility anomaly consisting of overelevation in adduction, often associated with ipsilateral hypertropia. The...
PURPOSE
Inferior oblique muscle overaction (IOOA) is an ocular motility anomaly consisting of overelevation in adduction, often associated with ipsilateral hypertropia. The weakening procedure of IO muscle is the most widely used procedure in IOOA. Usually, surgical planning is based on the degree of overaction of the IO muscle.
MATERIALS AND METHODS
We have retrospectively analyzed patients with bilateral IOOA with and without hypertropia in primary position, who underwent a bilateral IO weakening procedure. Both the amount of IOOA and the presence of a hypertropia in primary position were taken into consideration for the surgical plan.
RESULTS
Nineteen patients met the entry criteria for this study. In 12 patients, a hypertropia in primary position was present at baseline, and it was significantly lower after the asymmetrical IO weakening: 11 had an asymmetric IOOA at baseline, and one had symmetric IOOA. None of the remaining seven patients had a vertical deviation in primary position before surgery, despite having asymmetric IOOA. None of them developed a hypertropia in primary position after symmetric IO weakening.
CONCLUSIONS
Our findings outline the utility of considering both the presence of a vertical deviation in primary position and the magnitude of IOOA in this set of patients. Asymmetric inferior oblique weakening procedure is effective in treating a hypertropia in the primary position and bilateral IOOA.
Topics: Humans; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Retrospective Studies; Strabismus; Treatment Outcome; Vision, Binocular
PubMed: 34752189
DOI: No ID Found -
Journal of Neuro-ophthalmology : the... Mar 2022Ivanir and Trobe have claimed that hypertropia (HT) that is greater in upgaze than downgaze, or equal to it, is characteristic of decompensated congenital superior...
BACKGROUND
Ivanir and Trobe have claimed that hypertropia (HT) that is greater in upgaze than downgaze, or equal to it, is characteristic of decompensated congenital superior oblique (SO) palsy and never present in ischemic, traumatic, or tumorous SO palsy. The reliability of this claim was tested in patients with SO palsy confirmed by MRI demonstration of subnormal ipsilesional SO size.
METHODS
Quasi-coronal, surface coil MRI was performed in target-controlled central gaze to identify patients with a unilateral reduction in SO cross section indicative of palsy. Nine patients gave an unequivocal history or had markedly increased vertical fusional amplitudes indicative of congenital onset (mean age 38 ± 16 years, SD). Seven patients had unequivocal acquired onset (age 47 ± 14 years and symptom duration 5.4 ± 4.8 years), including 2 with demonstrated trochlear Schwannoma and 5 with onset after severe head trauma. Fifteen patients had gradually progressive onset unequivocally not congenital yet not associated with any identifiable precipitating event (age 52 ± 20 years and symptom duration 13 ± 14 years).
RESULTS
Maximum SO cross section averaged 8.6 ± 3.9 mm2 in congenital palsy, not significantly different from 11.3 ± 3.5 mm2 in acquired palsy (P = 0.08) either unequivocally or progressively acquired, but significantly less than about 19 mm2 contralesionally in SO palsy (P < 10-4). Although mean central gaze HT was greater at 20.6 ± 8.0Δ in 9 cases of congenital than that in 22 acquired cases at 11.4 ± 6.8Δ (P = 0.002), HT was 8.4 ± 16.3Δ less in upgaze than downgaze in congenital SO palsy and 3.7 ± 11.2Δ less in acquired SO palsy. In congenital palsy, 33% of patients had HT greater in upgaze than downgaze while in 67% HT was greater in downgaze (by up to 42Δ). In acquired SO palsy, HT was greater in upgaze than downgaze or equal to it in 8 cases (36%, P = 0.87, X2). In acquired SO palsy, HT was greater in upgaze than downgaze in 37% and greater in downgaze than upgaze in 59% of cases. The HT was equal in upgaze and centralgaze in no congenital and 3 acquired cases of SO palsy. Trends were similar in unequivocal acquired and progressive acquired (noncongenital) SO palsy (P > 0.4).
CONCLUSIONS
Hypertropia is not characteristically greater in upgaze than downgaze in congenital SO palsy proven by SO atrophy on MRI. In fact, average HT is greater in downgaze than upgaze in both acquired and congenital palsy, sometimes strikingly so in the latter. The finding of HT greater in upgaze than downgaze, or equal to it, does not reliably indicate that SO palsy is congenital, nor does maximum SO cross section.
Topics: Adult; Aged; Humans; Middle Aged; Oculomotor Muscles; Paralysis; Reproducibility of Results; Retrospective Studies; Strabismus; Trochlear Nerve Diseases; Young Adult
PubMed: 34670252
DOI: 10.1097/WNO.0000000000001301 -
Can Binocular Alignment Distinguish Hypertropia in Sagging Eye Syndrome From Superior Oblique Palsy?Investigative Ophthalmology & Visual... Sep 2022Although the three-step test (3ST) is typically used to diagnose superior oblique palsy (SOP), sagging eye syndrome (SES) has clinical similarities. We sought to...
PURPOSE
Although the three-step test (3ST) is typically used to diagnose superior oblique palsy (SOP), sagging eye syndrome (SES) has clinical similarities. We sought to determine if alignment measurements can distinguish unilateral SOP from hypertropia in SES.
METHODS
We studied hypertropic subjects who underwent surface-coil magnetic resonance imaging (MRI) demonstrating either SO cross-section reduction indicative of congenital or acquired palsy (SOP group) or lateral rectus muscle sag (SES group). Alignment was measured by Hess screen and prism-cover testing. Multiple supervised machine learning methods were employed to evaluate diagnostic accuracy. Rectus pulley coordinates were determined in SES cases fulfilling the 3ST.
RESULTS
Twenty-three subjects had unilateral SOP manifested by SO atrophy. Eighteen others had normal SO size but MRI findings of SES. Maximum cross-section of the palsied SO was much smaller than contralaterally and in SES (P < 2 × 10-5). Inferior oblique cross-sections were similar in SOP and SES. In both SOP and SES, hypertropia increased in contralateral and decreased in ipsilateral gaze and was greater in ipsilateral than contralateral head tilt. In SES, nine subjects (50%) fulfilled the 3ST and had greater infraplacement of the lateral than medial rectus pulleys in the hypotropic orbit. Supervised machine learning of alignment data distinguished the diagnoses with areas under the receiver operating curves up to 0.93, representing excellent yet imperfect differential diagnosis.
CONCLUSIONS
Because the 3ST is often positive in SES, clinical alignment patterns may confound SES with unilateral SOP, particularly acquired SOP. Machine learning substantially but imperfectly improves classification accuracy.
Topics: Humans; Oculomotor Muscles; Orbit; Paralysis; Retrospective Studies; Strabismus; Syndrome; Trochlear Nerve Diseases
PubMed: 36136043
DOI: 10.1167/iovs.63.10.13 -
Strabismus Sep 2021: The clinical features of congenital inferior rectus (IR) aplasia are similar to IR paresis/palsy, and they include hypertropia, limitation of downgaze - especially in...
: The clinical features of congenital inferior rectus (IR) aplasia are similar to IR paresis/palsy, and they include hypertropia, limitation of downgaze - especially in abduction, incyclotorsion, A-pattern strabismus, and abnormal head posture.: A 22-year-old man presented with a right face turn, small-angle hypertropia (14 prism diopters) in the right eye, and limitation of downgaze that passed the midline; no diplopia was present and supraduction was normal in that eye. Double Maddox rod revealed 12 degrees of incyclotorsion for the right eye. The Titmus test revealed a stereo acuity of 400 seconds of arc. Based on the preoperative clinical findings, a presumptive diagnosis of IR paresis was made and a surgical plan for performing superior rectus muscle recession and IR muscle resection was devised. Intraoperatively, forced duction test was positive in depression. To our surprise, after performing a 4 mm recession of the superior rectus muscle, we found that the IR muscle was absent. We then revised the surgical plan and performed a 6 mm resection and anterior transposition of the inferior oblique (IO) muscle. Post-operatively, the patient was orthophoric in the primary position without diplopia, and his abnormal head posture was significantly improved.: The amount of primary position hypertropia and severity of downgaze limitation are not adequate for differentiating congenital IR aplasia from IR paresis/palsy. Orbital imaging including CT, MRI or anterior segment optical coherence tomography (AS-OCT, UBM) is helpful to distinguish these two entities preoperatively.
Topics: Adult; Diplopia; Humans; Male; Ocular Motility Disorders; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Strabismus; Young Adult
PubMed: 34357853
DOI: 10.1080/09273972.2021.1948071