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Lee, Yoon, and Kim: Comparison of Double Maddox Rod Test and Bagolini Striated Lens Test for Superior Oblique Palsy
Original Article

J Korean Ophthalmol Soc 2015;57(5):837-842.

Published online: 7 September 2015

DOI: https://doi.org/10.3341/jkos.2016.57.5.837

Comparison of Double Maddox Rod Test and Bagolini Striated Lens Test for Superior Oblique Palsy

Si Eun Lee, MD, Sook Hyun Yoon, MD, Sook Young Kim, MD, PhD

Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea

Address reprint requests to Sook Young Kim, MD, PhD Department of Ophthalmology, Daegu Catholic University Hospital, #33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea Tel: 82-53-650-3000, Fax: 82-53-627-0133 E-mail: Leesea7015@naver.com

Received 6 August 201531 December 2015       Accepted 22 April 2016

© 2016 The 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 perm its unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We compared the results of the double Maddox rod test (DMRT), which is commonly performed in clinics as a subjective torsion test for superior oblique muscle palsy, with those of the Bagolini striated lenses test (BSLT) in a least dissociating condition to predict the cyclofusional capacity.

Methods

Twenty-five patients with acquired superior oblique muscle palsy were tested for degree of subjective torsion with DMRT and BSLT in primary position and down-gaze in Daegu Catholic University Hospital from May 2014 to March 2015. DMRT was performed in a dark room and BSLT in a lighted room.

Results

Mean extorsional degree in primary position was 3.40 ± 2.58° on DMRT and 1.88 ± 2.92° on BSLT, a significant difference (p = 0.000). In down-gaze, mean extorsional degree was 4.16 ± 2.90° with DMRT and 2.40 ± 2.90° with BSLT (p < 0.001).

Conclusions

The subjective torsional measurement with BSLT was significantly smaller than with DMRT, and the cyclofusional capacity in patients with acquired superior oblique palsy was 1.5° in primary position and 1.8° in down-gaze. BSLT is helpful in addition to DMRT and fundus photograph for the evaluation of cyclotropia in patients with superior oblique muscle palsy, and this test may yield clinically important information for predicting the cyclofusional capacity of patients with superior oblique muscle palsy.

Keywords: Bagolini striated lens test, Cyclofusional capacity, Double Maddox rod test, Subjective test for torsion, Superior oblique muscle palsy

References

1. von Noorden GK. Campos EC. Binocular vision and ocular Motility, Theory and management of strabismus. 6th. St. Louis: Mosby. 2002. p. 389–92.
2. Ruttum M. von Noorden GK. The Bagolini striated lens test for cyclotropia. Doc Ophthalmol. 1984; 58:131–9.
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3. von Noorden GK. Clinical observations in cyclodeviations. Ophthalmology. 1979; 86:1451–61.
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4. von Noorden GK. Murray E. Wong SY. Superior oblique paralysis. A review of 270 cases. Arch Ophthalmol. 1986; 104:1771–6.
5. Park KH. Shin JH. Kim SY. Surgical results of modified Harada-Ito operation for excyclotorsion. J Korean Ophthalmol Soc. 2012; 53:565–71.
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6. Park SW The torsional status of normal Koreans. J Korean Ophthalmol Soc. 2004; 45:1906–11.
7. Olivier P. von Noorden GK. Excyclotropia of the nonparetic eye in unilateral superior oblique muscle paralysis. Am J Ophthalmol. 1982; 93:30–3.
crossref
8. Na KS. Lee SY. Lee YC. Ocular torsion in unilateral superior oblique palsy. J Korean Ophthalmol Soc. 2007; 48:1388–93.
crossref

Table 1.
Demographics of subjects
Number of patients 25
Mean age (years) 52.4 ± 14.1
Gender (n, %)  
   Male 17 (68)
   Female 8 (32)
Superior oblique muscle palsy (n, %)  
   Right eye 7 (28)
   Left eye 10 (40)
   Both eyes 8 (32)

Values are presented as mean ± SD or n (%).

Table 2.
Comparison of the degree of extorsion between the double Maddox rod test (DMRT) and the Bagolini striated lens test (BSLT) in primary and down-gaze positions
  DMRT BSLT p-value
Primary gaze 3.40 ± 2.58° 1.88 ± 2.92° <0.001
Down-gaze 4.36 ± 2.77° 2.40 ± 2.90° <0.001
p-value 0.010 0.010  

Values are presented as mean ± SD unless otherwise indicated.

Table 3.
Comparison of the degree of extorsion between males and females measured by double Maddox rod test (DMRT) and Bagolini striated lens test (BSLT)
Male Female p-value
DMRT Primary gaze 3.47 ± 2.42° 3.25 ± 3.06° 0.861
Down-gaze 4.23 ± 2.91° 4.62 ± 2.62° 0.742
BSLT Primary gaze 1.59 ± 2.83° 2.50 ± 3.21° 0.504
Down-gaze 2.06 ± 2.82° 3.13 ± 3.14° 0.427

Values are presented as mean ± SD unless otherwise indicated.

Table 4.
Comparison of the degree of extorsion between the double Maddox rod test (DMRT) and the Bagolini striated lens test (BSLT) in primary and down-gaze positions for unilateral and bilateral superior oblique muscle palsy
    Primary gaze Down-gaze p-value
Unilateral SOM palsy DMRT 2.29 ± 1.45° 3.88 ± 2.20° <0.001
BSLT 1.24 ± 1.60° 1.76 ± 1.64° 0.011
p-value∗ 0.002 <0.001  
Bilateral SOM palsy DMRT 5.75 ± 2.96° 5.38 ± 3.66° 0.611
BSLT 3.25 ± 4.45° 3.75 ± 4.43° 0.350
p-value∗ 0.011 0.438  

Values are presented as mean ± SD unless otherwise indicated.

SOM = superior oblique muscle.

∗ Paired t-test.

Table 5.
Comparison of the degree of extorsion between unilateral and bilateral superior oblique muscle palsy measured by double Maddox rod test (DMRT) and Bagolini striated lens test (BSLT)
    Unilateral SOM palsy Bilateral SOM palsy p-value
DMRT Primary gaze 2.29 ± 1.45° 5.75 ± 2.96° 0.006
Down-gaze 3.88 ± 2.20° 5.38 ± 3.66° 0.313
BSLT Primary gaze 1.24 ± 1.60° 3.25 ± 4.50° 0.253
Down-gaze 1.76 ± 1.64° 3.75 ± 4.43° 0.254

Values are presented as mean ± SD unless otherwise indicated.

SOM = superior oblique muscle.

Table 6.
Comparison of the degree of extorsion between concordance and discordance groups on the double Maddox rod test (DMRT) and Bagolini striated lens test (BSLT) in acquired unilateral superior oblique muscle palsy
    Concordance group∗ Discordance group† p-value
DMRT Primary gaze 2.07 ± 1.27° 3.33 ± 2.08° 0.405
Down-gaze 3.79 ± 2.39° 4.33 ± 1.15° 0.573
BSLT Primary gaze 1.14 ± 1.35° 1.67 ± 2.29° 0.785
Down-gaze 1.43 ± 1.50° 3.33 ± 1.53° 0.147

Values are presented as mean ± SD unless otherwise indicated.

∗ Localized subjective extorsion to the paretic eye;

† Localized subjective extorsion to the non-paretic eye.

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