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Quantitative analysis of structure–function relationship between ocular motility and superior oblique muscle hypoplasia in unilateral superior oblique palsy
  1. Ji Eun Lee1,
  2. Hee Kyung Yang2,
  3. Jae Hyoung Kim3,
  4. Jeong-Min Hwang2
  1. 1 Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
  2. 2 Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
  3. 3 Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
  1. Correspondence to Dr Jeong-Min Hwang, Department of Ophthalmology, Seoul National University Bundang Hospital, Gyeonggi-do 13620, South Korea; hjm{at}


Aims To determine the structure–function relationship between the degree of superior oblique (SO) hypoplasia and ocular motility in unilateral SO palsy.

Methods A total of 166 patients with unilateral SO palsy were divided into three groups based on their aetiology and high-resolution MRI findings by an in-plane resolution of 0.25 mm: (1) congenital SO palsy and unilateral trochlear nerve agenesis (absent group, n=79), (2) congenital SO palsy and symmetric trochlear nerves on both sides (present group, n=40) and (3) acquired SO palsy (acquired group, n=47) who all had symmetric trochlear nerves on both sides. The degree of SO hypoplasia was defined as the ratio of SO area between the paretic and nonparetic sides (SOP/N) at the optic nerve–globe junction on MR images. Multivariate analysis was performed to investigate the relationship between SO hypoplasia and ocular motility parameters.

Results The degree of SO hypoplasia (SOP/N) showed a weak negative correlation with bilateral head tilt differences in all groups (β=−0.009, p<0.001 in the absent group; β=−0.003, p=0.034 in the present group; β=−0.007, p=0.002 in the acquired group). There was only a weak positive correlation with SOP/N and hypertropia differences between both gazes in the absent group (β=0.009, p<0.001) and the acquired group (β=0.007, p=0.001). In addition, none of the other ocular motility parameters were related to the degree of SO hypoplasia in all groups.

Conclusion Regardless of the aetiology of unilateral SO palsy, the structure–function relationship of the paretic SO size and ocular motility examination was weak and almost negligible.

  • muscles
  • diagnostic tests/Investigation
  • imaging

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  • JEL and HKY are equivalent first authors.

  • Contributors All authors contributed to conception, design and data collection. Literature screening, selection, preparation and review of the manuscript were performed by JEL, HKY and J-MH. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Seoul National University Bundang Hospital.

  • Provenance and peer review Not commissioned; internally peer reviewed.