June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Axis for Horizontal Ocular Rotation Is Unchanged by Surgical Correction of Esotropia
Author Affiliations & Notes
  • Joseph L Demer
    Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
    Neurology, University of California, Los Angeles, Los Angeles, California, United States
  • Robert A Clark
    Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
  • Footnotes
    Commercial Relationships   Joseph Demer None; Robert Clark None
  • Footnotes
    Support  NIH Grants EY008313 and EY00331, and Research to Prevent Blindness
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 5320. doi:
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    • Get Citation

      Joseph L Demer, Robert A Clark; Axis for Horizontal Ocular Rotation Is Unchanged by Surgical Correction of Esotropia. Invest. Ophthalmol. Vis. Sci. 2023;64(8):5320.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Since the eye does not rotate about its geometric center, normal horizontal eye rotation constitutes rolling movement with linear motion in the direction of rotation. We asked if this behavior is altered by esotropia (ET) or its surgical correction.

Methods : Surface coil magnetic resonance imaging (MRI) was performed in 2mm thick axial planes in target-controlled central gaze, and ~26° ab- and adduction, in 15 orthotropic controls (mean age 24± 5yrs, SD), 17 subjects (age 45±19 yrs) with untreated ET, with 9 (age 36±18 yrs) also imaged following surgical realignment by medial rectus (MR) recession. From MRI we computed eye centroids, rotation axes, and muscle lever arms.

Results : In controls, the eye translated 0.2±0.6mm posteriorly and 0.5±0.5mm laterally in abduction, but 0.3±0.8mm posteriorly and 0.5±0.3 mm medially in adduction. Similarly in untreated ET (P>0.1), the eye translated 0.1±0.6mm posteriorly and 0.4±0.4mm laterally in abduction, but 0.3±0.9mm posteriorly and 0.4±0.3mm medially in adduction. Nine subjects underwent bilateral MR recession averaging 5.7±0.5 mm, with additional 7mm lateral rectus plication in one. After surgical correction, translation remained statistically similar at 0.2±1.0mm posteriorly and 0.6±0.4mm laterally in abduction, but 0.2±0.6mm posteriorly and 0.5±0.5mm medially in adduction. For ~60° change from ad- to abduction, the initial rotation axis relative in controls was 0.4±1.1mm lateral and 0.2±1.9mm posterior to globe center. The axis in untreated ET differed significantly from normal at 1.2±1.6mm lateral and 1.1±2.8mm anterior (P<0.04 for both), but remained similar after surgical correction of ET at 0.8±2.0mm lateral and 0.2±2.4mm posterior (P>0.1). Lever arms for medial and lateral rectus muscles were similar in control subjects and ET before and after surgical correction.

Conclusions : The eye rotates about an eccentric axis, resulting in “rolling” motion in which horizontal translation is intrinsic to horizontal duction. Rotation axis eccentricity is slightly more lateral and posterior than normal in ET, but does not change significantly when ET is corrected by medial rectus recession surgery, and is not associated with significant changes in lever arms for the horizontal rectus muscles. This fortunate finding indicates that eccentric ocular rotation is not a factor that is changed by strabismus surgery.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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