Pulled-in-two (PIT) syndrome is a sudden rupture of the extraocular muscle during strabismus surgery, typically with minimal tension intraoperatively without excessive force. This is a rare occurrence and this study reports cases from a single centre over a seven-year period. Of 11,824 surgery cases, four patients had PIT syndrome giving an incidence of 0.034%. All were female with mean age at surgery of 61.75 ±8.99 years. None had previous ocular surgery and all were eso with very large angles of 100-120PD. Two had 6th nerve palsy and two were myopic strabismus. Three had medial rectus rupture and one lateral rectus. Surgical repair was required – usually muscle recovery and reattachment of the muscle, or, if the muscle was lost, a transposition surgery. Postoperative alignment was ortho to +25PD. This represents a serious complication of strabismus surgery and potential risk factors were identified as advanced age, prior surgery, cranial nerve palsy, thyroid eye disease and degenerative extraocular muscle disease.
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Features and outcomes of pulled-in-two syndrome
Reviewed by Fiona Rowe
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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