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(Investigative Ophthalmology and Visual Science. 2007;48:1133-1138.)
© 2007 by The Association for Research in Vision and Ophthalmology, Inc.
DOI:  10.1167/iovs.06-0769
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Model-Based Improvements in the Treatment of Patients with Strabismus and Axial High Myopia

Robert Hoerantner,1,2 Thomas Kaltofen,3 Siegfried Priglinger,4 Christian-Michael Fock,1,5 Michael Buchberger,3 and Thomas Haslwanter3,6

1From the Departments of Ophthalmology and 5Radiology, Krankenhaus der Barmherzigen Schwestern (Good Sisters Hospital), Ried, Austria; 2Department of Ophthalmology, University Hospital Graz, Austria; the 3Department for Medical Informatics Upper Austrian Research GmbH, Hagenberg, Austria; 4Department of Ophthalmology, Krankenhaus der Barmherzigen Brüder (Good Brothers Hospital), Linz, Austria; and the 6Department of Medical Technology, Upper Austrian University of Applied Sciences, Linz, Austria.

PURPOSE. Eye motility disorders with axial high myopia and an enlarged globe are often characterized by a hypotropia of the affected eye, usually referred to as heavy-eye syndrome. Based on an intuitive interpretation of magnetic resonance (MR) images, the cause of the hypotropia has typically been assigned to the rectus muscles. In this study, the hypothesis that the oblique muscles play an important role in the underlying biomechanical disorder of this type of strabismus was investigated.

METHODS. The hypothesis was tested by (1) a retrospective analysis of surgical results in one patient with unilateral axial high myopia; and (2) MR images of orbital tissues in two further patients with unilateral axial high myopia.

RESULTS. MR images demonstrated a pattern of extraocular muscle path displacements similar to those described previously, but also a uniform decrease in the cross-sectional area of the inferior oblique muscles. Computer modeling required decreased inferior oblique contractility in addition to displaced extraocular muscle paths to recreate the observed motility pattern accurately.

CONCLUSIONS. Patients with axial high myopia regularly show a reduction in the diameter of the inferior oblique. The resultant reduction in muscle-strength is important for the correct explanation of this complex eye movement disorder.






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Copyright © 2007 by the Association for Research in Vision and Ophthalmology