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LETTER TO EDITOR
Year : 2010  |  Volume : 58  |  Issue : 6  |  Page : 556-557

Author's reply: Vertical synergistic divergence: A distinct separate entity


Pediatric Ophthalmology and Strabismus Clinic, Dr. Thakorbhai V Patel Eye Institute, Haribhakti Complex, Salatwada, Vadodara - 390 001, Gujarat, India

Date of Web Publication16-Oct-2010

Correspondence Address:
Jitendra Jethani
Pediatric Ophthalmology and Strabismus Clinic, Dr. Thakorbhai V Patel Eye Institute, Haribhakti Complex, Salatwada, Vadodara - 390 001, Gujarat
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Jethani J. Author's reply: Vertical synergistic divergence: A distinct separate entity. Indian J Ophthalmol 2010;58:556-7

How to cite this URL:
Jethani J. Author's reply: Vertical synergistic divergence: A distinct separate entity. Indian J Ophthalmol [serial online] 2010 [cited 2019 Oct 20];58:556-7. Available from: http://www.ijo.in/text.asp?2010/58/6/556/71697

Dear Editor,

I read the comments given by Pandey et al. [1] It is difficult to understand how they could convert this case [2] into a bilateral Brown's syndrome (BS) case. The only finding that bilateral superior oblique overaction is present does not point to a bilateral BS. The child on elevation of the left eye showed a direct depression of the right eye [Figure 1]. There is a limitation of the right eye in depression. Why should that happen in a bilateral BS? The lid retraction was present in downgaze [2] and not in adduction, very similar to one seen in pseudo-Von Graefe's sign. The adduction, depression in abduction, and elevation in adduction were restricted in the right eye but not in the left. [2] A right eye BS would not have the limitation of depression in abduction as was seen in our case. [2] The ductions were completely normal in the left eye and so a question of BS in the left eye does not arise. No Marcus Gunn jaw wink was seen which was supposedly completing the jigsaw puzzle for the authors. A forced duction test was not overlooked but the child was not cooperative and his parents did not consent for general anesthesia. [2] Not everything can be written about the case (which was discussed with the reviewers) because of the word limit.
Figure 1: The picture clearly demonstrates the restricted depression and eyeball moving downward in the vertical gaze

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The authors have wasted time and space by writing more and more about bilateral BS which was not necessary. [1] I have put up my explanation which happens to be contrary to the opinion of Pandey et al. [1] In science, one should respect other's opinion and I would just respect their opinion.

 
  References Top

1.
Pandey PK, Dadeya S, Singh A, Vats P, Rathi N. Misinnervation in 3rd nerve palsy: Vertical synergistic divergence or consummate congenital bilateral asymmetrical Brown's syndrome with congenital ptosis? Indian J Ophthalmol 2010;58:55-6  Back to cited text no. 1
    
2.
Jethani J. Misinnervation in third nerve palsy: Vertical synergistic divergence. Indian J Ophthalmol 2009;57:476-7.  Back to cited text no. 2
[PUBMED]  Medknow Journal  


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