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Purpose: To estimate the frequency of slipped extraocular muscle (SM) in cases of repeat strabismus surgery and to compare the results of a number of putative preoperative tests for the detection of SM, with direct intraoperative inspecti on and histologic confirmation. Design: Retrospective analysis of audit records followed by prospective interventional case series. Participants: Case records o f 715 adults presenting for repeat surgical correction of horizontal strabismus. Five patients suspected of having horizontal SM were consecutively recruited fo r the prospective case series. Methods: Slipped extraocular muscle frequencywas determined retrospectively from surgical outcome data in 715 adult horizontal st rabismus surgeries in 1 center. A separate prospective study examined 5 particip ants with putative SM in detail. Gaze-dependent clinical tests (squint magnitud e, eye movement range, palpebral fissure widening, naked-eye saccadic velocity estimation, intraocular pressure change) and saccade main sequence parameters (i nfrared eyetracking) were recorded before and 2 weeks after corrective surgery. Intraoperative diagnosiswasmade by direct muscle examination and confirmed by hi stologic examination. Length of slippage and forced duction tests were intraoper ative outcome measures. Results: Slipped extraocular muscle frequency was 10.6% . The muscles of 3 participants in the prospective series were slipped. Direct i ntraoperative inspection accurately identi-fied allSMcases. All other clinical tests produced false-positive and false-negative results, although SM was sugg ested preoperatively by limited eye movement range. Distorted saccadic velocity profiles were significantly ( P < 0.0001) associated with prior strabismus surge ry. Saccade main sequence parameters were not diagnostic for SM. Conclusions: Di rect intraoperative inspection can accurately diagnose SM. Preoperative diagnosi s of long-standing SM was not possible. In contradiction to a previous report, SM was not reliably associated with reduced peak saccadic velocity. The associat ion between distorted saccadic velocity profiles and previous strabismus surgery is, to our knowledge, reported here for the first time.
Purpose: To estimate the frequency of slipped extraocular muscle (SM) in cases of repeat strabismus surgery and to compare the results of a number of putative preoperative tests for the detection of SM, with direct intraoperative inspecti on and histologic confirmation. Design: Retrospective analysis of audit records followed by prospective interventional case series. Participants: Case records of 715 adults presenting for repeat surgical correction of horizontal strabismus. Five patients suspected of having horizontal SM were consecutively recruited fo r prospective case series. Methods: Slipped extraocular muscle frequency waswas A separate prospective study examined 5 participant with putative SM in detail. Gaze-dependent clinical tests (squint magnitud e, eye movement range, palpebral fissure widening, naked- eye saccadic velocity estimation, intraocular pressure chang e) and saccade main sequence parameters (i nfrared eyetracking) were recorded before and 2 weeks after corrective surgery. Intraoperative diagnosis was made by direct muscle examination and confirmed by hi stologic examination. Length of slippage and forced duction tests were intraoper ative outcome measures. Slipped extraocular muscle frequency was 10.6%. The muscles of 3 participants in the prospective series were slipped. Direct i ntraoperative inspection accurately identi-fied all SMcases. All other clinical tests produced false-positive and false-negative results, although SM was sugg ested preoperatively Distorted saccadic velocity profiles were significantly (P <0.0001) associated with prior strabismus surge ry. Saccade main sequence parameters were not diagnostic for SM. Conclusions: Di rect intraoperative inspection can accurately diagnose SM. Preoperative diagnosi s of long -standing SM was not possible. In contradiction to a previous report, SM was not reliably associated with reduced peak saccadic velocity. The associat ion between distorted saccadic velocity profiles and previous strabismus surgery is, to our knowledge, reported here for the first time.