Evidence map›Paper›PMID 26983977›Full record

ArticleOphthalmology2016

Rectus Pulley Displacements without Abnormal Oblique Contractility Explain Strabismus in Superior Oblique Palsy.

Soh Youn Suh, Alan Le, Robert A Clark, Joseph L Demer

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Ophthalmology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 1 pooled it
3.4field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.

  1. Surgical interventions for vertical strabismus in superior oblique palsy.The Cochrane database of systematic reviews · 2017
    Pooled it
  2. Article
  3. Functional Anatomy of Ocular Counter-Rolling in Superior Oblique Palsy.Investigative ophthalmology & visual science · 2025
    Article
  4. Article
  5. Article
  6. Masquerading Superior Oblique Palsy.American journal of ophthalmology · 2022
    Article
  7. Article
  8. Article
  9. Range of forced cyclorotation in superior oblique palsy and V-pattern strabismus.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2021
    Article
  10. Article
  11. Inferior rectus displacement in heavy eye syndrome and sagging eye syndrome.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2020
    Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Review
  17. What's new for us in strabismus?Indian journal of ophthalmology · 2017
    Review
  18. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

Soh Youn SuhDepartment of Ophthalmology, David Geffen Medical School at University of California, Los Angeles, Los Angeles, California.
Alan LeDepartment of Ophthalmology, David Geffen Medical School at University of California, Los Angeles, Los Angeles, California; Neuroscience Interdepartmental Program, David Geffen Medical School at University of California, Los Angeles, Los Angeles, California; Bioengineering Interdepartmental Program, David Geffen Medical School at University of California, Los Angeles, Los Angeles, California.
Robert A ClarkDepartment of Ophthalmology, David Geffen Medical School at University of California, Los Angeles, Los Angeles, California.
Joseph L DemerDepartment of Ophthalmology, David Geffen Medical School at University of California, Los Angeles, Los Angeles, California; Neuroscience Interdepartmental Program, David Geffen Medical School at University of California, Los Angeles, Los Angeles, California; Bioengineering Interdepartmental Program, 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. Electronic address: jld@jsei.ucla.edu.
University of California, Los Angeles · US

Funding

Vision Research Core at UCLAP30EY000331 · NEI · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI Gregory Darin Field, DAVID S WILLIAMS · 1985 to 2026
$16.8M
BIOMECHANICAL ANALYSIS IN STRABISMUS SURGERYR01EY008313 · NEI · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI JOSEPH Louis DEMER · 1991 to 2026
$15.0M
NEI NIH HHS P30 EY000331NEI NIH HHS R01 EY008313
6 · The paper itself

Abstract

purposeUsing high-resolution magnetic resonance imaging (MRI), we investigated whether rectus pulleys are significantly displaced in superior oblique (SO) palsy and whether displacements account for strabismus patterns.

designProspective case-control study.

participantsTwenty-four patients diagnosed with SO palsy based on atrophy of the SO muscle on MRI and 19 age-matched orthotropic control subjects.

methodsHigh-resolution, surface coil MRI scans were obtained in multiple, contiguous, quasicoronal planes during monocular central gaze fixation. Pulley locations in oculocentric coordinates in the following subgroups of patients with SO palsy were compared with normal results in subgroups of patients with SO palsy: unilateral versus bilateral, congenital versus acquired, and isotropic (round) versus anisotropic (elongated) SO atrophy. Expected effects of pulley displacements were modeled using Orbit 1.8 (Eidactics, San Francisco, CA) computational simulation.

main outcome measuresRectus pulley positions and ocular torsion.

resultsRectus pulleys typically were displaced in SO palsy. In unilateral SO palsy, on average the medial rectus (MR) pulley was displaced 1.1 mm superiorly, the superior rectus (SR) pulley was displaced 0.8 mm temporally, and the inferior rectus (IR) pulley was displaced 0.6 mm superiorly and 0.9 mm nasally from normal. Displacements were similar in bilateral SO palsy, with the SR pulley additionally displaced 0.9 mm superiorly. However, the lateral rectus pulley was not displaced in either unilateral or bilateral SO palsy. The SR and MR pulleys were displaced in congenital SO palsy, whereas the IR and MR pulleys were displaced in acquired palsy. Pulley positions did not differ between isotropic and anisotropic palsy or between patients with cyclotropia of less than 7° versus cyclotropia of 7° or more. Simulations predicted that the observed pulley displacements alone could cause patterns of incomitant strabismus typical of SO palsy, without requiring any abnormality of SO or inferior oblique strength.

conclusionsRectus pulley displacements alone, without abnormal oblique muscle contractility, can create the clinical patterns of incomitant strabismus in SO palsy. This finding supports accumulating evidence that clinical binocular misalignment patterns are not reliable indicators of contractile function of the SO muscle. Ocular torsion does not correlate with and thus cannot account for pulley displacements in SO palsy.

Indexed as

AdolescentAdultAgedAged, 80 and overCase-Control StudiesChildChild, PreschoolDiplopiaEye MovementsFemaleHumansInfantMagnetic Resonance ImagingMaleMiddle AgedMuscle Contraction

Identifiers

PMID26983977
PMCPMC4877286
OpenAlexW2295449949

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.