Degeneration of Orbital Pulleys in Elderly Patients with Diplopia
Toshiaki Goseki, MD,PhD; Manami Kawai, CO; Hitoshi Ishikawa, MD, PhD; Nobuyuki Shoji, MD, PhD
Kitasato University, Department of Ophthalmology
1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagwa, Japan
Introduction: In recent years, with the development of diagnostic imaging, diagnosis of diplopia induced by the degeneration of orbital pulleys has increased. We studied elderly patients with diplopia who could not be diagnosed by conventional testing and compared their MRI to those of controls.
Methods: The participants included 57 patients (73.2±6.9 years) who exhibited esotropia or vertical strabismus and did not present with cranial nerve palsy, systemic illness, or ocular injury. They were chosen from among 236 patients aged 60 years or older, who visited Kitasato University Hospital for bilateral diplopia between 2014 and 2017. Seventeen age-matched individuals were chosen as controls (69.8 ± 4.9 years). The participants were classified into three groups: esotropia (21 cases), vertical strabismus (22 cases), and combined esotropia and vertical strabismus (14 cases) The examined items included the lateral rectus tilting angle (LRT), lateral rectus sagging angle (LRS), lateral rectus–superior rectus open angle (LR-SR-OA), and LR–SR band condition (LR-SR-BC).
Results: The results for the esotropia, vertical strabismus, combined strabismus, and control groups were as follows: LRT: -21.6°, -21.8°, -18.8°, -13.3°, LRS: -12.5°, -11.6°, -5.6°, -7.0°, LR–SR-OA: 114.8°, 111.9°, 104.0°, 106.1°, and LR–SR-BC: 2.8, 2.9, 2.9, 1.9: 4-level, respectively.
Discussion: The LRT, LRS, and LR-SR-OA displayed significant differences between the two groups (the esotropia and vertical strabismus) and the control. The LR-SR-BC was significantly different between the three groups and the control.
Conclusion: We found that many of the diplopia patients who could not be diagnosed by conventional testing had orbital pulley disorders.
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