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Lee, Kim, and Kim: Changes in Ocular Excyclotorsion According to Graded Inferior Oblique Recession
Original Article

J Korean Ophthalmol Soc 2016;57(8):1268-1273.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.8.1268

Changes in Ocular Excyclotorsion According to Graded Inferior Oblique Recession

Donghun Lee, MD, Won Jae Kim, MD, Myung Mi Kim, MD, PhD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Myung Mi Kim, MD, PhD Department of Ophthalmology, Yeungnam University Hospital, #170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: 82-53-620-3441, Fax: 82-53-626-5936 E-mail: mmk@med.yu.ac.kr

Received 3 March 2016       Revised 21 April 2016       Accepted 27 May 2016

Copyright © 2016 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate changes in ocular excyclotorsion in patients with inferior oblique overaction (IOOA) according to amount of correction by graded inferior oblique recession and to compare the amount of excyclotorsion between primary IOOA and secondary IOOA.

Methods

This study included 54 eyes of 54 patients who were diagnosed with unilateral IOOA and underwent graded inferior oblique recession. Fundus photographs were taken pre- and postoperatively. The sum of angles of torsion of both eyes was used to analyze changes in excyclotorsion. The angle of excyclotorsion was analyzed using the ImageJ program.

Results

Eighteen eyes were grade 2, 24 eyes were grade 3 and 12 eyes were grade 4. Preoperative angle of excyclotorsion was 16.23 ± 5.96˚ for the patients with grade 2 eyes, 18.83 ± 5.76˚ for the patients with grade 3 eyes and 29.00 ± 10.23˚ for the patients with grade 4 eyes. Therefore, as the degree of IOOA increased, the amount of excyclotorsion became larger. There was no statistical significance between grade 2 and grade 3 (p = 0.467), however, there was a statistically significant difference between grade 3 and grade 4 (p < 0.001). Postoperative angle of excyclotorsion was significantly decreased in each group (grade 2: p = 0.020, grade 3: p < 0.001, grade 4: p = 0.041). The amount of surgical recession of inferior oblique muscle showed a positive correlation with a decrease in the angle of excyclotorsion, but was not statistically significant. The amount of excyclotorsion and the decrease of excyclotorsion after surgery were larger in secondary IOOA than in primary IOOA, but were not statistically significant (p = 0.260).

Conclusions

As the preoperative degree of IOOA increased, the amount of correction of excyclotorsion became larger but there is no statistical significance. Correction of IOOA and excylclotorsion is expected after graded inferior oblique recession.

Keywords: Excyclotorsion, Graded inferior oblique recession, Inferior oblique overaction

References

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Figure 1.
The angle of excyclotorsion measured using ImageJ program. The angle significantly decreased after graded inferior oblique recession. (A) Preoperative measurement. (B) Postoperative measurement.
jkos-57-1268f1.tif
Figure 2.
Comparison of amount of preoperative excyclotorsion according to inferior oblique overaction grade using ANOVA test. Values are presented as mean ± SD.
jkos-57-1268f2.tif
Table 1.
Baseline characteristics of patients
Factors Value
Number of patients 54
Age (years) 10.43 ± 10.73
Gender (male:female) 25:29
Mean SE refractive errors (diopters)  
 Operated eye –0.88 ± 2.21
 Fellow eye –0.38 ± 1.83
Result of stereotest  
 Lang Ⅰ test, passed (%) 77.8 (42/54)
 Stereo Fly Stereotest (seconds of arc) 599.81 ± 1,094.47
Mean period of fundus photo taken after surgery (months) 6.74 ± 6.64
Type of IOOA  
 Primary IOOA (IOOA only) 13
 Secondary IOOA (IOOA + SOP) 41
IOOA Grade  
 +2 18
 +3 24
 +4 12

Values are presented as mean ± SD unless otherwise indicated. SE = spherical equivalent; IOOA = inferior oblique overaction; SOP = superior oblique palsy.

Table 2.
Changes in excyclotorsion after graded inferior oblique recession
  N Preoperative angle of excyclotorsion (˚) Postoperative angle of excyclotorsion (˚) Amount of correction (˚) p-value*
IOOA Grade +2 18 16.23 ± 5.96 13.68 ± 6.26 2.56 ± 4.24 0.020
IOOA Grade +3 24 18.83 ± 5.76 14.77 ± 6.36 4.06 ± 4.87 <0.001
IOOA Grade +4 12 29.00 ± 10.23 22.67 ± 8.73 6.33 ± 6.01 0.041
Total 54 20.23 ± 8.44 16.16 ± 7.65 4.06 ± 5.05 <0.001

Values are presented as mean ± SD.

IOOA = inferior oblique overaction.

* Paired t-test.

Table 3.
Comparison of amount of excyclotorsion between primary IOOA and secondary IOOA
  N Preoperative angle of excyclotorsion (˚) Postoperative angle of excyclotorsion (˚) Amount of correction (˚) p-value*
Primary IOOA 13 16.31 ± 5.94 13.63 ± 6.26 2.68 ± 4.23 0.042
Secondary IOOA 41 21.46 ± 8.79 16.97 ± 7.94 4.50 ± 5.25 <0.001

Values are presented as mean ± SD.

IOOA = inferior oblique overaction.

* Paired t-test.

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