Analysis of the effect of inferior oblique overaction on the retinal layers and choroidal thicknesses

The aim of this study is to determine central macular thickness (CMT) and subfoveal choroid thickness (SFCT) in eyes with inferior oblique muscle overaction (IOOA) using spectral domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) mode, as well as macular layers using OCT segmentation software. In this retrospective study, OCT parameters collected from 42 eyes with unilateral IOOA were compared to those from 39 contralateral healthy eyes. The CMT and SFCT were measured using EDI SD-OCT, and each retinal layer was measured using SD-OCT in the central 1, 3, 6 mm areas identified by the Early Treatment Diabetic Retinopathy Study (ETDRS). Heidelberg segmentation was used to define the different layers of the macula. There were no morphological abnormalities in the macula in either eyes with unilateral IOOA or contralateral healthy eyes. The CMT, SFCT, and retinal layer thickness did not differ statistically between IOOA eyes and contralateral healthy eyes (P>0.05). Subgroups of IOOA eyes based on concomitant strabismus, which included IOOA only, IOOA plus esotropia, and IOOA plus exotropia, or by degree of IOOA, which included mild and severe forms, also revealed negligible differences in CMT, SFCT, and other retinal layer thickness (P=0.34, P=0.91, P>0.05, respectively) The total thickness of the ganglion cell and inner plexiform layer decreased non-significantly in severe IOOA compared to mild IOOA (P=0.059). Furthermore, the outer plexiform layer was non-significantly thicker in IOOA plus esotropia eyes (p=0.052). Despite the fact that IOOA had no discernible impact on CMT, SFCT, or macular layers, it is critical that this finding be confirmed by further large-scale studies comparing patients to healthy individuals.

PDF

___

1. Wright K. Alphabet Patterns and Oblique Muscle Dysfunctions. In: Handbook of Pediatric Strabismus and Amblyopia. 1st edition. Springer, New York, 2006;289-300.
2. Meyer E, Ludatscher RM, Zonis S. Primary and secondary overacting inferior oblique muscles: an ultrastructural study. Br J Ophthalmol. 1984;68:416-20.
3. Korn BS, Burkat CN, Carter DK. Anatomy of the extraocular muscles. in: basic and clinical science course, pediatric ophthalmology and strabismus. Am Academy Ophthalmol San Francisco. 2019-2020;19-21.
4. Bron AJ, Tripathi RC, Tripathi BJ. The extra-ocular muscles and ocular movements. In: Wolff’s Anatomy of the Eye and Orbit. 8th edition. Hodder Arnold Publication, London, 1997:107-76.
5. Yalcin B, Ozan H. Insertional pattern of the inferior oblique muscle. Am J Ophthalmol. 2005;139:504-8.
6. Elmassri A. Relation of macular and other holes to the insertion of the inferior oblique. Br J Ophthalmol. 1963;47:90-4.
7. Ersan I, Oltulu R, Altunkaya O, et al. Relationship of inferior oblique overaction to macular and subfoveal choroidal thickness. J AAPOS. 2015;19:21-3.
8. Gonzalez Caldito N, Antony B, He Y, et al. Analysis Of Agreement Of Retinal-Layer Thickness Measures Derived From The Segmentation Of Horizontal And Vertical Spectralis OCT macular scans. Curr Eye Res. 2018;43:415-23.
9. Szigeti A, Tátrai E, Szamosi A, et al. A morphological study of retinal changes in unilateral amblyopia using optical coherence tomography image segmentation. PLoS One. 2014;9:e88363.
10. Kasem MA, Badawi AE. Changes in macular parameters in different types of amblyopia: optical coherence tomography study. Clin Ophthalmol. 2017;11:1407-16.
11. Read SA, Collins MJ, Vincent SJ, et al. Choroidal thickness in childhood. Invest Ophthalmol Vis Sci. 2013;54:3586-93.
12. Park K-A, Oh SY. Analysis of spectral-domain optical coherence tomography in preterm children: retinal layer thickness and choroidal thickness profiles. Invest Ophthalmol Vis Sci. 2012;53:7201-7.
13. Chakraborty R, Read SA, Collins MJ. Diurnal variations in axial length, choroidal thickness, intraocular pressure, and ocular biometrics. Invest Ophthalmol Vis Sci. 2011;52:5121-9.
14. Yuvaci I, Pangal E, Yuvaci S, et al. An evaluation of effects of different mydriatics on choroidal thickness by examining anterior chamber parameters: the scheimpflug imaging and enhanced depth imaging-OCT study. J Ophthalmol. 2015:981274.
15. Oner V, Bulut A, Oter K. The effect of topical anti-muscarinic agents on subfoveal choroidal thickness in healthy adults. Eye (Lond). 2016;30:925- 8.
16. Codenotti M, Iuliano L, Fogliato G, et al. A novel spectral-domain optical coherence tomography model to estimate changes in vitreomacular traction syndrome. Graefes Arch Clin Exp Ophthalmol. 2014;252:1729-35.
17. Duker JS, Kaiser PK, Binder S, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmol. 2013;120:2611-9.
18. Kozak I, Barteselli G, Sepah YJ, et al. Correlation of vitreomacular traction with foveal thickness, subfoveal choroidal thickness, and vitreomacular/ foveal angle. Curr Eye Res. 2017;42:297-301.
19. Miura M, Arimoto G, Tsukahara R, et al. Choroidal thickness after scleral buckling. Ophthalmol. 2012;119:1497-8.
20. Kimura M, Nishimura A, Yokogawa H, et al. Subfoveal choroidal thickness change following segmental scleral buckling for rhegmatogenous retinal detachment. Am J Ophthalmol. 2012;154:893-900.
21. Odrobina D, Laudańska-Olszewska I, Gozdek P, et al. Influence of scleral buckling surgery with encircling band on subfoveal choroidal thickness in long-term observations. Biomed Res Int. 2013;2013:586894.
22. Kasem MA, Sabry D. Detection of macular changes by optical coherence tomography after inferior oblique muscle surgery. J AAPOS. 2011;15:334- 7.