{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T07:21:08Z","timestamp":1774941668678,"version":"3.50.1"},"reference-count":5,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2009,12,1]],"date-time":"2009-12-01T00:00:00Z","timestamp":1259625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2009,12,1]],"date-time":"2009-12-01T00:00:00Z","timestamp":1259625600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["OVS"],"published-print":{"date-parts":[[2009,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose.<\/jats:title>\n                    <jats:p>To report a patient with congenital fibrosis of the extraocular muscles showing either synergistic divergence or adduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report.<\/jats:title>\n                    <jats:p>A 7\u2010year\u2010old girl presented with complaints of abnormal eye movement since early childhood. A detailed ophthalmologic examination was performed. On ophthalmologic evaluation, her corrected visual acuities were 20\/50 OU. She had 12 prism diopters of exotropia at distance and near in the primary position. During attempted right gaze, OU abducted. During attempted left gaze, the right eye adducted or abducted. Upgaze and downgaze were limited. Levator function was evaluated at 0 mm with a marginal reflex distance of \u22121 in OU. On thin\u2010section brain stem magnetic resonance imaging, the left abducens nerve was absent, and the right and left oculomotor nerves were severely hypoplastic. The oculomotor nerve was smaller than the acoustic nerve was, and this was interpreted as hypoplasia according to a previous method (Kim and Hwang, Ophthalmology 2005;112:728\u201332). The medial and superior recti of OU were atrophic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions.<\/jats:title>\n                    <jats:p>A patient with congenital fibrosis of the extraocular muscles may show alternatively either synergistic divergence or adduction, which has not been documented before.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/opx.0b013e3181be9db3","type":"journal-article","created":{"date-parts":[[2009,11,25]],"date-time":"2009-11-25T06:24:54Z","timestamp":1259130294000},"page":"1386-1388","source":"Crossref","is-referenced-by-count":6,"title":["Variable Synergistic Divergence"],"prefix":"10.1002","volume":"86","author":[{"given":"Jae Hyoung","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Radiology Seoul National University College of Medicine Seoul National University Bundang Hospital Seongnam Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeong\u2010Min","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Seoul National University College of Medicine Seoul National University Bundang Hospital Seongnam Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2009,12,1]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/S0161-6420(87)33346-9","article-title":"Congenital unilateral adduction deficit with simultaneous abduction. A variant of Duane\u2019s retraction syndrome","volume":"94","author":"Wagner RS","year":"1987","journal-title":"Ophthalmology"},{"key":"e_1_2_5_3_2","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.ophtha.2004.12.006","article-title":"Hypoplastic oculomotor nerve and absent abducens nerve in congenital fibrosis syndrome and synergistic divergence with magnetic resonance imaging","volume":"112","author":"Kim JH","year":"2005","journal-title":"Ophthalmology"},{"key":"e_1_2_5_4_2","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/S0161-6420(98)94029-5","article-title":"Hereditary external ophthalmoplegia synergistic divergence, jaw winking, and oculocutaneous hypopigmentation: a congenital fibrosis syndrome caused by deficient innervation to extraocular muscles","volume":"105","author":"Brodsky MC","year":"1998","journal-title":"Ophthalmology"},{"key":"e_1_2_5_5_2","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1002\/ana.410410306","article-title":"Oculomotor nerve and muscle abnormalities in congenital fibrosis of the extraocular muscles","volume":"41","author":"Engle EC","year":"1997","journal-title":"Ann Neurol"},{"key":"e_1_2_5_6_2","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.ophtha.2004.06.040","article-title":"Presence of the abducens nerve according to the type of Duane\u2019s retraction syndrome","volume":"112","author":"Kim JH","year":"2005","journal-title":"Ophthalmology"}],"container-title":["Optometry and Vision Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1097\/OPX.0b013e3181be9db3","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1097\/OPX.0b013e3181be9db3","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1097\/OPX.0b013e3181be9db3","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:48:54Z","timestamp":1774936134000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1097\/OPX.0b013e3181be9db3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,12]]},"references-count":5,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2009,12]]}},"alternative-id":["10.1097\/OPX.0b013e3181be9db3"],"URL":"https:\/\/doi.org\/10.1097\/opx.0b013e3181be9db3","archive":["Portico"],"relation":{},"ISSN":["1040-5488","1538-9235"],"issn-type":[{"value":"1040-5488","type":"print"},{"value":"1538-9235","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,12]]}}}