Histopathological features and satellite cell population characteristics in human inferior oblique muscle biopsies: clinicopathological correlation.

Purpose: To investigate the correlation between clinical characteristics and histopathological and immunohistochemical features of inferior oblique muscles in patients with primary and secondary inferior oblique overaction.

Methods: Inferior oblique muscle specimens of patients who underwent inferior oblique-weakening procedures for primary or secondary inferior oblique overaction were recruited. Subjects were mainly divided into two groups, each of which was further divided into two subgroups: group 1 included patients with primary inferior oblique overaction (subgroups, infantile esotropia vs acquired V-pattern esotropia), and group 2 included patients with secondary inferior oblique overaction (subgroups, congenital vs acquired trochlear nerve palsy). Inferior oblique overaction was graded between 0-4. Histopathologic changes, such as angular fibers, endo- and perimysial fibrosis, and vacuolization were categorized from mild to severe. Immunohistochemical markers Pax7, NCAM, and MyoD1 were used to detect satellite cells, a unique stem cell population in muscles presumably responsible from myofiber regeneration and maintenance, and their activity. Results were reported as stained cells per cross-section ratio.

Results: A total of 51 patients were included: 36 in group 1 and 15 in group 2. Satellite cell distribution and activity was significantly higher in group 1 (P < 0.001). The angular fiber count and the degree of perimysial fibrosis was higher in the secondary group (P < 0.001 and P = 0.01, resp.). There was no correlation between clinical amount of inferior oblique muscle overaction and immunohistochemical markers.

Conclusions: The differences in immunohistochemical parameters supported with histopathological changes between different strabismus etiologies imply that satellite cell population behavior varies among strabismus types.