{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:22:56Z","timestamp":1787775776405,"version":"build-2784847793"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,10]]},"abstract":"Abstract<\/jats:title>\n \n Purpose:<\/jats:title>\n To report the long-term outcomes of bilateral symmetrical superior oblique (SO) nasal tenotomy in patients with large A-pattern exotropia (\u226525 prism diopter [PD]).<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n This retrospective study was conducted on 15 patients (aged: 4\u201328 years) of large A-pattern exotropia. An A-pattern was defined as >10 PD difference between up and down gaze at 6 m by use of the alternate prism cover test. Objective ocular torsion was assessed by fundus photography and subjective torsion by double Maddox rod test. All patients underwent horizontal muscle surgery according to the primary position horizontal deviation and bilateral symmetrical SO nasal tenotomy for A-pattern. Surgical success was defined as postoperative A-pattern of \u226410 PD, the absence of vertical and torsional diplopia, and the absence of V-pattern. The minimum follow-up period was 24 months.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n A total of 15 patients of large A-pattern exotropia (7 males and 8 females) with a mean age of 17.09 \u00b1 7.9 years were included in the study. All patients had bilateral SO overaction of grade +3 or +4 with a mean preoperative A-pattern of 30.3 \u00b1 3.9 PD. At 24 months of follow-up, esotropia in down gaze (V-pattern) was present in four patients with a mean of 11.25 \u00b1 2.5 PD, (range, 10\u201315 PD). The rest of the 11 patients maintained successful alignment with a mean A-pattern of 3.18 \u00b1 1.17 PD, (range, 2\u20135 PD). There was significant A-pattern collapse with a mean of 31 \u00b1 9.1 PD after 2 years of follow-up, which was significantly associated with preoperative A-pattern (Pearson correlation,\n r<\/jats:italic>\n = 0.7;\n t<\/jats:italic>\n [\n 15<\/jats:sup>\n ] = 4.0;\n P<\/jats:italic>\n = 0.002). The mean of pre- and postoperative objective ocular torsion was found to be \u22120.5 \u00b1 4\u00b0 and \u22124.8 \u00b1 3.8\u00b0 with a mean extorsion effect of 4.67 \u00b1 3.85\u00b0. There was a statistically significant difference between pre- and postoperative ocular torsion (\u00b0) (\n t<\/jats:italic>\n [30] = 5.42;\n P<\/jats:italic>\n < 0.001), the change in ocular torsion was significantly associated with preoperative torsion (Pearson correlation,\n r<\/jats:italic>\n = 0.5;\n t<\/jats:italic>\n [30] = 7.2;\n P<\/jats:italic>\n < 0.001). None of the patients had subjective torsion on the double Maddox rod test pre- and postoperatively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Bilateral symmetrical SO nasal tenotomy is effective in cases with large A-pattern (>25 PD). The reduction of A-pattern and postoperative change in fundus torsion have a positive correlation with preoperative A-pattern and preoperative torsion, respectively.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/joco.joco_175_23","type":"journal-article","created":{"date-parts":[[2024,9,10]],"date-time":"2024-09-10T15:57:59Z","timestamp":1725983879000},"page":"375-380","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Surgical Outcomes of Bilateral Symmetrical Superior Oblique Nasal Tenotomy in Patients of Large A-Pattern Exotropia"],"prefix":"10.4103","volume":"35","author":[{"given":"Pramod Kumar","family":"Pandey","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, ESIC Medical College, Faridabad, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anupam","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sreeram","family":"Jayaraj","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupal","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Panyala","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev Kumar","family":"Mittal","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barun","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,8,10]]},"reference":[{"key":"R1-20240910","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1136\/bjo.59.10.553","article-title":"Graduated recession of the superior oblique muscle","volume":"59","author":"Caldeira","year":"1975","journal-title":"Br J Ophthalmol"},{"key":"R2-20240910","doi-asserted-by":"crossref","first-page":"321","DOI":"10.3928\/0191-3913-19790901-13","article-title":"Posterior tenectomy of the superior oblique","volume":"16","author":"Prieto-Diaz","year":"1979","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"R3-20240910","doi-asserted-by":"crossref","first-page":"211","DOI":"10.3928\/0191-3913-19960901-03","article-title":"Posterior superior oblique tenectomy at the scleral insertion for collapse of A-pattern strabismus","volume":"33","author":"Shin","year":"1996","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"R4-20240910","doi-asserted-by":"crossref","first-page":"101","DOI":"10.3928\/0191-3913-19910301-11","article-title":"Superior oblique silicone expander for Brown syndrome and superior oblique overaction","volume":"28","author":"Wright","year":"1991","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"R5-20240910","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.jaapos.2012.05.003","article-title":"The efficacy of superior oblique Z-tenotomy in the treatment of overdepression in adduction (superior oblique overaction)","volume":"16","author":"Brooks","year":"2012","journal-title":"J AAPOS"},{"key":"R6-20240910","doi-asserted-by":"crossref","first-page":"112","DOI":"10.3928\/0191-3913-19830501-06","article-title":"Superior oblique recession versus tenotomy: A comparison of surgical results","volume":"20","author":"Buckley","year":"1983","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"R7-20240910","doi-asserted-by":"crossref","first-page":"2639","DOI":"10.1177\/1120672120968726","article-title":"Graded superior oblique tendon suture lengthening: A novel procedure","volume":"31","author":"Xia","year":"2021","journal-title":"Eur J Ophthalmol"},{"key":"R8-20240910","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/09273972.2015.1130063","article-title":"Effects of bilateral superior oblique \u201chang-back\u201d recession in treatment of A-pattern strabismus with superior oblique overaction","volume":"24","author":"Li","year":"2016","journal-title":"Strabismus"},{"key":"R9-20240910","doi-asserted-by":"crossref","first-page":"417","DOI":"10.5935\/0004-2749.20190079","article-title":"Evaluation of three superior oblique surgical weakening procedures for A-pattern strabismus","volume":"82","author":"Yu","year":"2019","journal-title":"Arq Bras Oftalmol"},{"key":"R10-20240910","doi-asserted-by":"crossref","first-page":"284","DOI":"10.3928\/0191-3913-20050901-10","article-title":"Effect of posterior tenectomy of the superior oblique on objective and subjective torsion in cases of superior oblique overaction","volume":"42","author":"Sharma","year":"2005","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"R11-20240910","first-page":"569","article-title":"Inferior oblique weakening surgery on ocular torsion in congenital superior oblique palsy","volume":"8","author":"Lee","year":"2015","journal-title":"Int J Ophthalmol"},{"key":"R12-20240910","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12886-019-1298-4","article-title":"The efficacy of superior oblique posterior tenectomy in the treatment of A-pattern exotropia without ocular intorsion: A retrospective study","volume":"20","author":"Wei","year":"2020","journal-title":"BMC Ophthalmol"},{"key":"R13-20240910","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.ajo.2009.06.016","article-title":"Effect of 10-mm superior oblique posterior tenectomy combined with frenulum dissection in A-pattern with superior oblique overaction","volume":"148","author":"Heo","year":"2009","journal-title":"Am J Ophthalmol"},{"key":"R14-20240910","doi-asserted-by":"crossref","first-page":"199","DOI":"10.3928\/0191-3913-19920701-03","article-title":"Results of combined surgery on the superior oblique and horizontal rectus muscles for A-pattern horizontal strabismus","volume":"29","author":"Shuey","year":"1992","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"R15-20240910","doi-asserted-by":"crossref","first-page":"222.e1","DOI":"10.1016\/j.jaapos.2020.04.012","article-title":"Bilateral superior oblique temporal tenectomy for the treatment of A-pattern strabismus","volume":"24","author":"Debert","year":"2020","journal-title":"J AAPOS"},{"key":"R16-20240910","first-page":"173","article-title":"Graded recessions of the superior oblique muscle: Biomechanical analysis of their effects upon its vertical, torsional and horizontal force components","volume":"16","author":"Castanera","year":"2001","journal-title":"Binocul Vis Strabismus Q"},{"key":"R17-20240910","doi-asserted-by":"crossref","first-page":"1.e1","DOI":"10.1016\/j.jaapos.2017.12.001","article-title":"Why strabismus surgery works: The legend of the dose-response curve","volume":"22","author":"Archer","year":"2018","journal-title":"J AAPOS"},{"key":"R18-20240910","first-page":"33","article-title":"Bilateral superior oblique tenotomy for A-pattern strabismus in patients with fusion","volume":"3","author":"Reynolds","year":"1988","journal-title":"Binocul Vis"},{"key":"R19-20240910","first-page":"134","article-title":"A complication in weakening the superior oblique muscle in A-pattern exotropia","volume":"15","author":"Rubin","year":"1984","journal-title":"Ophthalmic Surg"},{"key":"R20-20240910","doi-asserted-by":"crossref","first-page":"364","DOI":"10.5935\/0004-2749.20140091","article-title":"Measurement of ocular torsion variation following superior oblique tenectomy","volume":"77","author":"Ducca","year":"2014","journal-title":"Arq Bras Oftalmol"},{"key":"R21-20240910","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1111\/aos.14201","article-title":"Clinical measurements of normative subjective cyclotorsion and cyclofusion in a healthy adult population","volume":"98","author":"Flodin","year":"2020","journal-title":"Acta Ophthalmol"},{"key":"R22-20240910","first-page":"7","article-title":"Disinsertion of the superior oblique for A-pattern anisotropias","volume":"2","author":"Prieto-Diaz","year":"1987","journal-title":"Binocul Vis"},{"key":"R23-20240910","first-page":"95","article-title":"Superior oblique recession. An update","volume":"17","author":"Prieto-D\u00edaz","year":"2002","journal-title":"Binocul Vis Strabismus Q"},{"key":"R24-20240910","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s12009-000-0013-6","article-title":"Partial and total tenotomy of superior oblique muscle","volume":"32","author":"\u00d6zkan","year":"2000","journal-title":"Ann Ophthalmol"}],"container-title":["Journal of Current Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/joco.joco_175_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:42:06Z","timestamp":1787773326000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/joco.joco_175_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10]]},"references-count":24,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.4103\/joco.joco_175_23","relation":{},"ISSN":["2452-2325"],"issn-type":[{"value":"2452-2325","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10]]},"assertion":[{"value":"2023-08-21","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-25","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}