title: Classifying medial rectus muscle attachment in consecutive exotropia.
abstract: To evaluate interexaminer agreement in classifying medial rectus muscle attachment in patients with consecutive exotropia.
  
  
  
  A series of intraoperative photographs of 26 eyes in 25 patients who underwent surgery for consecutive exotropia were retrospectively studied. Two examiners independently classified the medial rectus attachment as either normal, stretched scar, slipped muscle, or lost muscle. Agreement between examiners was evaluated using the weighted kappa (κ) statistic, and causes of disagreement were assessed.
  
  
  
  Agreement was found in 15 of 26 eyes (58%), signifying "moderate" agreement (κ = 0.41). Approximately two-thirds of the disagreements, 7 of 11 eyes (64%), were between stretched scar and slipped muscle, with characteristics of each entity being present in the same muscle.
  
  
  
  The clinical distinction between stretched scar and slipped muscle appears to be obscure. We propose that they should be considered a single entity, which could be referred to as "abnormal scleral attachment."
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Jung
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors.forename: David A
authors.initials: DA
authors.lastname: Leske
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota. Electronic address: holmes.jonathan@mayo.edu.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005099:Exotropia / Q000145:classification* / Q000601:surgery*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000145:classification*; D012189:Retrospective Studies; D015348:Vision, Binocular / Q000502:physiology; D055815:Young Adult