Superior oblique extraocular muscle shape in superior oblique palsy.
OBJECTIVE
To investigate the superior oblique (SO) extraocular muscle cross section in normal controls and in SO palsy using high-resolution magnetic resonance imaging (MRI).


METHODS
Prospective observational study.


METHODS
At a single academic medical center, high-resolution MRI was obtained at 312 μm in-plane resolution using surface coils in multiple, contiguous, quasi-coronal planes perpendicular to the orbital axis in 12 controls and 62 subjects with SO palsy. Previous strabismus surgery was excluded. Imaging was repeated in central gaze and infraduction. In each image plane along the SO, its cross section was outlined to compute cross-sectional area and the major and minor axes of the best-fitting ellipse. Main outcome measures were SO morphology and ocular motility.


RESULTS
The major and minor axes, cross-sectional area distributions, and volume of the SO belly were subnormal in orbits with SO palsy at most anteroposterior locations (P = .001), but discriminant analysis showed that palsied SO cross sections segregated distinctly into round and elongate shapes representing isotropic vs anisotropic atrophy, respectively. The major axis was relatively preserved in anisotropic atrophy (P = .0146). Cases with isotropic atrophy exhibited greater hypertropia in infraversion than central gaze, as well as greater excyclotorsion, than cases with anisotropic atrophy (P < .05 for all).


CONCLUSIONS
Characteristic differences in shape of the palsied SO belly correlate with different clinical features, and may reflect both the degree of differential pathology in the medial vs lateral neuromuscular SO compartments and the basis for diversity in patterns of resulting hypertropia.
Department of Ophthalmology, David Geffen Medical School at University of California, Los Angeles, Los Angeles, California; Department of Ophthalmology and Visual Science, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Sun Young
SY
Shin
Department of Ophthalmology, David Geffen Medical School at University of California, Los Angeles, Los Angeles, California; Stein Eye Institute, David Geffen Medical School at University of California, Los Angeles, Los Angeles, California; Department of Neurology, David Geffen Medical School at University of California, Los Angeles, Los Angeles, California; Neuroscience, David Geffen Medical School at University of California, Los Angeles, Los Angeles, California; Bioengineering Interdepartmental Programs, David Geffen Medical School at University of California, Los Angeles, Los Angeles, California. Electronic address: jld@jsei.ucla.edu.
Joseph L
JL
Demer
D000293:Adolescent; D000328:Adult; D001284:Atrophy; D002648:Child; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000033:anatomy & histology / Q000473:pathology*; D011446:Prospective Studies; D013285:Strabismus / Q000175:diagnosis*; D020432:Trochlear Nerve Diseases / Q000175:diagnosis*; D055815:Young Adult