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Range of forced cyclorotation in superior oblique palsy and V-pattern strabismus

  • Pediatrics
  • Published:
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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.

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Funding

This study was supported by the National Research Foundation of Korea funded by the Ministry of Science, ICT, and Future Planning (2017R1C1B5017453; Seoul, South Korea).

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Authors and Affiliations

  1. Department of Ophthalmology, Ajou University Hospital, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea

    Seung Ah Chung & Seong Jung Ha

  2. Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

    Jae Ho Jung

Authors
  1. Seung Ah Chung
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  2. Seong Jung Ha
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Contributions

Design of the study: SAC. Conduct of the study: SAC and SJH. Collection and management of data: SAC and SJH. Analysis and interpretation of data: SAC and JHJ. Preparation, review, or approval of the manuscript: SAC, SJH, and JHJ.

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Correspondence to Seung Ah Chung.

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Conflict of interest

The authors declare that they have no conflicts of interest.

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Not required.

Ethics approval

This study was conducted in accordance with the tenets of the Declaration of Helsinki. The study protocol was approved by the Institutional Review Board of Ajou University School of Medicine, Suwon, South Korea (AJIRB-MED-OBS-20-096).

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Chung, S.A., Ha, S.J. & Jung, J.H. Range of forced cyclorotation in superior oblique palsy and V-pattern strabismus. Graefes Arch Clin Exp Ophthalmol 259, 1035–1043 (2021). https://doi.org/10.1007/s00417-020-04994-0

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  • DOI: https://doi.org/10.1007/s00417-020-04994-0

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