Bdeer Nayrouz, Hadar Noa, Raveh Doris, Obied Basel, Richard Stephen, Zahavi Alon, Goldenberg-Cohen Nitza
Faculty of Medicine, Hadassah Hebrew University, Jerusalem 91120, Israel.
Bnai-Zion Medical Center, Ophthalmology Department, Haifa 3339419, Israel.
Children (Basel). 2023 Sep 11;10(9):1536. doi: 10.3390/children10091536.
To report the rate of ocular torsion in children with horizontal strabismus or orthophoria.
A retrospective study design was used. Nineteen children were included in the study, including seven girls, aged 4-16 years. All patients were examined for strabismus and 12 were scheduled for surgical intervention. All participants had digital fundus photos (DRSplus, Padova, Italy) of both eyes at presentation, and 5 of 12 also had fundus photos following the strabismus operation. Patient files were reviewed for age, demographic data, type of strabismus, clinical symptoms and signs, orthoptic exams, subjective and objective reports of torsion, inferior oblique overaction, and V pattern. Fundus photos were analyzed for torsion by ImageJ software [ImageJ 1.54f, National Institute of Health, USA]. The disc-foveal angle was calculated for ocular torsion. Disc-foveal angle was defined as the angle formed between a line passing through the center of the optic disc to the fovea and another horizontal line passing through the center of the optic disc, using fundus photographs.
Of the 19 children, 18 had horizontal strabismus: 9 with exotropia and 9 with esotropia. One child was orthophoric with torsional strabismus. Inferior oblique overaction was detected in all but 3 children, while V pattern was documented in 10. Visual acuity was reduced (under 6/12) in four eyes of four children. None were symptomatic for ocular torsion. Although extorsion was documented clinically in 3 of 19 children, it was measurable on fundus photos in all patients before surgery with a mean of 8.7 ± 8.5 degrees and 8.5 ± 9.7 degrees in the right and left eyes, respectively. The mean extorsion in both eyes was 19.7 ± 10.1 degrees and improved to a mean of 15.3 ± 7.9 degrees in the children who were operated on and had documented postoperative fundus photographs.
Extorsion was detected on fundus photos at a significantly higher rate than in clinical examination. Notably, inferior oblique overaction was mainly associated with torsion. This study demonstrated that torsion is underdiagnosed in clinical examinations, as the children are often asymptomatic, but fundus photos which are easily obtained can improve its detection.
报告水平斜视或正视儿童的眼扭转发生率。
采用回顾性研究设计。19名儿童纳入研究，其中7名女孩，年龄4 - 16岁。所有患者均接受斜视检查，12例计划接受手术干预。所有参与者就诊时均有双眼数字眼底照片（DRSplus，意大利帕多瓦），12例中的5例在斜视手术后也有眼底照片。查阅患者病历，记录年龄、人口统计学数据、斜视类型、临床症状和体征、视光学检查、扭转的主观和客观报告、下斜肌亢进及V型模式。使用ImageJ软件[ImageJ 1.54f，美国国立卫生研究院]分析眼底照片的扭转情况。通过眼底照片计算视盘 - 黄斑中心凹夹角以评估眼扭转。视盘 - 黄斑中心凹夹角定义为通过视盘中心与黄斑中心的连线和另一条通过视盘中心的水平线所形成的夹角。
19名儿童中，18例有水平斜视：9例外斜视，9例内斜视。1例儿童为伴有扭转性斜视的正视眼。除3例儿童外，其余均检测到下斜肌亢进，10例记录有V型模式。4名儿童的4只眼睛视力下降（低于6/12）。均无眼扭转症状。虽然临床记录19例儿童中有3例存在外旋，但所有患者术前眼底照片均可测量到扭转，右眼平均为8.7±8.5度，左眼平均为8.5±9.7度。双眼平均外旋为19.7±10.1度，接受手术且有术后眼底照片记录的儿童，平均改善至15.3±7.9度。
眼底照片检测到的外旋发生率显著高于临床检查。值得注意的是，下斜肌亢进主要与扭转相关。本研究表明，由于儿童通常无症状，眼扭转在临床检查中诊断不足，但易于获取的眼底照片可提高其检出率。
