Risk of consecutive esotropia after surgery for intermittent exotropia according to passive duction force

Hyunkyoo Kang; Hyun Jin Shin; Andrew G. Lee

doi:10.1371/journal.pone.0281392

Peer Review History

Original SubmissionAugust 22, 2022
29 Nov 2022 Decision Letter - Abdelrahman M. Elhusseiny, Editor PONE-D-22-23505Risk of Consecutive Esotropia after Surgery for Intermittent Exotropia according to Passive Duction ForcePLOS ONE Dear Dr. Shin, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jan 13 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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We will update your Data Availability statement to reflect the information you provide in your cover letter." Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The manuscript is clearly written with reasonable conclusions and discussion of the strengths and weaknesses of the paper. One suggestion to make the discussion more flow more easily is to relate the paragraph starting on line 239 back to the author's own study. The manuscript is sound, however it may be wise to also include how this can be relevant to those without access to the tension measuring device. Reviewer #2: I want to commend the authors on an interesting paper on a very difficult surgical topic. Over and under correction is always the most challenging and frequent complication of strabismus surgery and they describe an interesting, non-invasive way to try and lower that risk. I think they aptly describe the weaknesses of the study - the small number in the consecutive group especially. They do a very nice job of laying this out though and giving all of the information rather than coming down with concrete conclusions. I think that it would be interesting to see the comparison of this group with bilateral lateral rectus recessions. Overall, this is well written, interesting and formulates reasonable conclusions. Reviewer #3: 1- Abstract Results: Please mention the number of patients in each group 2- Introduction: The introduction needs to be shortened and focused on the hypothesis of the study. The authors postulate that patients who develop consecutive ET after surgery for XT have either a larger PDF for the medial rectus muscle or smaller PDF of the lateral rectus muscle which explain their exaggerated response to surgery. This should be mentioned clearly in the introduction 3- Line 90: What is the authors’ definition of significant oblique dysfunction? 4- Methods: The surgical dose should be mentioned in the manuscript with references 5- Table 1: What is the unit used for stereopsis? 6- Results: The outcome of the surgeries is not clear. We only know that 8 cases had consecutive ET. What was the mean postoperative angle? Howe many patient was orthotropic? How many had residual XT? Would the authors compare the PDF in those who were orthotropic to those with residual XT looking for higher PDF in the lateral rectus in those with residual XT? ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: Yes: Ahmed Awadein ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0281392.r001
Revision 1
10 Jan 2023 Author Response REQUEST FOR REVISION PONE-D-22-23505 Risk of Consecutive Esotropia after Surgery for Intermittent Exotropia according to Passive Duction Force Dear Editorial officer, We are deeply grateful for the reviewer’s sincere and valuable comments that have resulted in significant manuscript improvements. We would also like to thank the editorial member of PLOS ONE for their interest in this paper. We hope that our responses satisfactorily address the reviewer’s concerns. Reviewer #1 The manuscript is clearly written with reasonable conclusions and discussion of the strengths and weaknesses of the paper. 1) One suggestion to make the discussion more flow more easily is to relate the paragraph starting on line 239 back to the author's own study. Thank you very much for your kind review. As your comment, we described the clinical implication of measurement PDF in the last part of the paragraph (line 255-257 of page 13) as following: “Based on the results of the present study, we believe that a reduction in the surgical amount should be carefully considered in patients with a large PDF in their MRM relative to the ipsilateral LRM to prevent consecutive ET.” 2) The manuscript is sound, however it may be wise to also include how this can be relevant to those without access to the tension measuring device. Alternative method is forced duction test (FDT). FDT is a simple and easy method for clinically evaluating the mechanical properties of the extraocular muscles (EOMs). However, the results from the FDT are highly dependent on the experience and skill of clinicians, and also this test cannot be used to detect small pathological changes. Thus, the authors have designed a simple and compact device for quantitatively and continuously measuring the passive duction force in EOMs. We hope to soon be able to make our device accessible to other surgeons as well. Reviewer #2 I want to commend the authors on an interesting paper on a very difficult surgical topic. Over and under correction is always the most challenging and frequent complication of strabismus surgery and they describe an interesting, non-invasive way to try and lower that risk. I think they aptly describe the weaknesses of the study - the small number in the consecutive group especially. They do a very nice job of laying this out though and giving all of the information rather than coming down with concrete conclusions. I think that it would be interesting to see the comparison of this group with bilateral lateral rectus recessions. Overall, this is well written, interesting and formulates reasonable conclusions. Thank you very much for your kind review and valuable comments. Basically, our surgical management of intermittent exotropia is a R&R procedure. As your suggestion, we will measure the PDF of the lateral rectus in the patient who underwent LROU recession. We believe that the results of this preliminary study would help to plan a further randomized controlled trial (conventional surgical dose group vs. Adjusted surgical dose group according to the results of PDF) in the future. Reviewer #3: 1- Abstract Results: Please mention the number of patients in each group As your comment, we added the number of patients in each group in the result section of Abstract as following: “Of these 70 patients, 8 CET and 62 NCET patients were present.” 2- Introduction: The introduction needs to be shortened and focused on the hypothesis of the study. The authors postulate that patients who develop consecutive ET after surgery for XT have either a larger PDF for the medial rectus muscle or smaller PDF of the lateral rectus muscle which explain their exaggerated response to surgery. This should be mentioned clearly in the introduction Thank you for your good comment. We changed the introduction section shortened and focused on the hypothesis of the study. 3- Line 90: What is the authors’ definition of significant oblique dysfunction? ‘Significant oblique dysfunction’ indicated inferior (or superior) oblique overaction (or underaction) of +2 or more. We added this point in the Material and Methods section 4- Methods: The surgical dose should be mentioned in the manuscript with references As your suggestion, we added the surgical dose as Table 1 (page 6) 5- Table 1: What is the unit used for stereopsis? Stereoacuity (arcsec) was transformed to log units for analysis. We added this point in the statistical analyses and Table 2 6- Results: The outcome of the surgeries is not clear. We only know that 8 cases had consecutive ET. What was the mean postoperative angle? Howe many patient was orthotropic? How many had residual XT? Would the authors compare the PDF in those who were orthotropic to those with residual XT looking for higher PDF in the lateral rectus in those with residual XT? Thank you for your good comment. The mean deviation angles at postoperative 1 month were -3.9±6.5 PD at far and -2.6±7.9 PD at near. 26 patients (37.1%) had ≤10 ET, 19 patients (27.1%) were orthotropic, and 17 patients (24.3%) had residual XT at 1 month after surgery. In response to your comments, we added this in the result section As you mentioned, PDF in those with residual XT had a higher relative PDF in the lateral rectus (13.1 vs. 0.1). This is our next research topic “Risk of Undercorrection after Surgery for Intermittent Exotropia according to Passive Duction Force” We will publish this result after this study. We are deeply grateful for your sincere and valuable comments that have resulted in significant improvements to our manuscript. We have revised our manuscript as suggested and have answered all questions to the best of our abilities. We hope that our responses satisfactorily address your concerns. Attachments Attachment Submitted filename: response to reviewers comments.docx https://doi.org/10.1371/journal.pone.0281392.r002
23 Jan 2023 Decision Letter - Abdelrahman M. Elhusseiny, Editor Risk of Consecutive Esotropia after Surgery for Intermittent Exotropia according to Passive Duction Force PONE-D-22-23505R1 Dear Dr. Shin, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Abdelrahman M. Elhusseiny Academic Editor PLOS ONE Additional Editor Comments (optional): None Reviewers' comments: None https://doi.org/10.1371/journal.pone.0281392.r003
Formally Accepted
8 Feb 2023 Acceptance Letter - Abdelrahman M. Elhusseiny, Editor PONE-D-22-23505R1 Risk of Consecutive Esotropia after Surgery for Intermittent Exotropia according to Passive Duction Force Dear Dr. Shin: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Abdelrahman M. Elhusseiny Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0281392.r004

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