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Biomedical subjects

H S Metz

Publications and source records attributed to H S Metz.

At least 19 recordsLinked to original sources
PubMed1991

Treatment of unilateral acute sixth-nerve palsy with botulinum toxin.

We studied 29 consecutive patients with acute unilateral sixth-nerve palsy, who received botulinum toxin injection to the antagonist medial rectus muscle. The average interval between onset of palsy and treatment was 40 days and the mean follow-up from the last injection was 14 months. Before treatment, esotropia in the primary position ranged from 12 to 45 prism diopters and limitation to abduction in the affected eye ranged from -2 (approximately 15 degrees lateral to midline) to -6 (15 degrees nasal to midline). After treatment, 22 of 29 patients (76%) had complete recovery of motility as determined by version testing. Of the seven patients with a residual abduction deficit, two had fusion in the primary position, three had fusion with prismatic correction, and two patients required subsequent surgery. Botulinum toxin injection seems to be an effective treatment option in cases of acute unilateral sixth-nerve palsy.

Abducens Nerve↗
PubMed1990

Strabismus caused by melanoma metastatic to an extraocular muscle.

Nonocular melanoma rarely metastasizes to the orbit. We report the case of a melanoma presumably arising from an axillary lymph node sinus that metastasized to the left medial rectus muscle causing proptosis, diplopia, and reduced saccadic velocity measurements. Clinical, radiographic, and histopathologic data are presented and discussed.

Adult↗
PubMed1988

Botulinum toxin treatment of acute sixth and third nerve palsy.

Thirty-four patients with acute sixth nerve palsy and nine patients with acute third nerve palsy were treated with botulinum toxin injection to the antagonist, nonparalytic horizontal rectus muscle. In a control group of 52 patients with acute sixth nerve palsy not treated with botulinum in the acute stage, only 16 (31%) recovered spontaneously and did not require surgery. Twenty-two of the 31 surviving patients who could be followed with acute sixth nerve palsy had lateral rectus recovery and surgery was avoided. Four required prisms in their glasses to obtain fusion. Nine patients developed chronic sixth nerve palsy and required surgery. In this group of acute sixth nerve palsy patients, eleven were bilateral. Seven of these eleven developed chronic sixth nerve paralysis, and required strabismus surgery. This suggests the prognosis for recovery following botulinum treatment in cases of acute bilateral sixth nerve palsy is not as good as in the unilateral cases. Botulinum toxin treatment does not appear to be effective in chronic sixth nerve palsy, as judged by results of treatment in one patient known to have a chronic palsy. Nine of nine patients with acute third nerve palsy had medial rectus recovery with fusion horizontally in primary gaze. None have required surgery. Only four of nine showed improvement in vertical rotations. The remaining five patients avoid vertical diplopia by a compensatory chin position. Botulinum toxin treatment of patients with acute sixth and third nerve palsy appears beneficial. However, since some in this group of patients may recover spontaneously, a randomized, double-blind study may be necessary to more definitively determine the effectiveness of this therapy.

Abducens Nerve↗
PubMed1988

The use of vertical offsets with horizontal strabismus surgery.

A series of 83 patients had vertical displacement of the horizontal rectus muscle insertions monocularly along with recession-resection surgery to correct comitant, vertical strabismus coexisting with a horizontal deviation. Using a surgical plan of approximately 1 mm of displacement of both the medial and lateral rectus insertions to correct each prism diopter (PD) of vertical deviation, 67% of patients had no residual vertical strabismus, and 80% had 2 PD or less of vertical strabismus. Mean follow-up time was 18 months (minimum, 6 weeks). Little change was noted in the vertical deviation after the 1-month postoperative examination. Transposition appeared to have no effect on the results of surgery for the horizontal strabismus.

Female↗
PubMed1987

The use of sodium hyaluronate as a biologic sleeve in strabismus surgery.

Strabismus surgery sometimes fails because of the mechanical restriction caused by the development of fibrous adhesions between the operated muscle and the surrounding tissues. Reoperation increases the frequency and severity of mechanical restriction significantly because of additional scar formation. Attempts to isolate the muscle from other tissues using gelatin sponges or Supramid plastic sleeves have been unsuccessful because of the body's reaction to these permanent foreign bodies. We used an ultra-pure fraction of sodium hyaluronate to study whether this nonantigenic, noninflammatory, viscoelastic substance could function as a temporary sleeve to prevent or reduce scarring and mechanical restriction following strabismus surgery. We resected the superior rectus muscle of 14 eyes from seven 5- to 7-pound white rabbits. In one eye, we instilled sodium hyaluronate 1% around the muscle. The other eye served as a control. The rabbits were killed at five, seven, ten, 14, 21, 28, and 42 days. Ante mortem length-tension measurements and post mortem histologic examinations of the operated muscles were performed in a blinded fashion. The results suggested, but did not definitely demonstrate, that sodium hyaluronate may reduce postoperative adhesions.

Animals↗
PubMed1979

Double elevator palsy.

Of 15 patients with monocular limitation of elevation, six had no deviation in primary gaze while the remaining nine had hypotropia of the involved eye. Twelve of 15 patients had restriction to upgaze on forced duction testing. Eleven of these 12 had normal upward saccadic velocity, which suggested normal elevator function. Four patients had reduced saccadic velocity, which indicated true elevator weakness. Superior rectus muscle paresis alone could account for limited elevation and would reduce upward saccadic speed. Patients with a diagnosis of "double elevator palsy" only infrequently (about one quarter of cases) have palsy of an elevator muscle and may have only a single elevator palsy. The identification of a true elevator weakness is most important in planning management.

Electrooculography↗
PubMed1979

Adjustable suture strabismus surgery.

The adjustable muscle recession procedure is described. The criteria for patient selection are reviewed as well as the surgical results during the past 5 years when the technique has been in active use. The philosophy behind the adjustable suture technique is the following: a procedure which would allow the surgeon to bring ocular alignment to a favorable position at the time of the first postoperative dressing change would be of significant value. Adjustable suture surgery is just such a technique. It does not insure a successful result. The ophthalmologist must still decide upon the preferred eye position. The surgeon is merely allowed to come closer to his desired immediate postoperative alignment by the ability to adjust muscle position after surgery.

Adolescent↗
PubMed1979

Saccadic velocity measurements in Brown's syndrome.

Eleven patients with Brown's syndrome (12 eyes) had vertical saccades measured in the primary, adducted, and abducted positions. Upward saccades in all 3 positions were equal and within the normal average velocity range. There was no difference between upward velocities in the eyes with Brown's syndrome when compared with the opposite, normal eye. These findings are consistent with the restrictive etiology of Brown's syndrome and may be helpful in confirming the diagnosis in some patients.

Electrooculography↗
PubMed1978

The O'Connor cinch revisited.

The modified O'Connor cinch operation is a useful, but little used, adjustable resection operation. For increased understanding of its shortening and adjustment characteristics, a standard cinch was performed in animals and patients with strabismus. Animal studies showed that, as each strand of the cinch was removed, a small, relatively equal release of the cinch effect occurred. Measurement of the shortening obtained in patients with strabismus showed a consistent resection effect of about 4 mm. Review of 17 cases in which the cinch was used as part of the surgical treatment showed the technique to be adjustable by reducing the overcorrection in 6 cases. Ten to 20 prism dioptres of reduction in the deviation was obtained with adjustment of the cinch on the first postoperative day. All 17 cases had satisfactory adjustment. The largest residual deviation was 12 prism dioptres.

Adolescent↗
PubMed1978

Saccadic velocity studies in Möbius syndrome.

Eight patients with Möbius syndrome were examined and their eye movements studied with horizontal saccadic velocity measurements. A marked decrease in velocity of horizontal saccades was noted, indicating both medial and lateral rectus weakness. Significant esotropia, when present, may be improved with conventional recession-resection surgery.

Abnormalities, Multiple↗
PubMed1977

The treatment of A and V patterns by monocular surgery.

Eleven patients with "A" or "V" pattern strabismus and the absence of notable oblique muscles overactions, were operated on, using the technique of monocular vertical displacement of the horizontal rectus muscles. The average correction of the A or V pattern was 16.5 delta. Subjective torsional complaints were not reported by any of the patients. Torsion was measured postoperatively with the Maddox rod, Maddox wing, and amblyoscope. The average torsional measurement, at least one month postoperatively, was 1.6 degrees with a range of 0 degrees to 7 degrees. It was concluded that monocular vertical displacement of the horizontal rectus muscles can result in satisfactory correction of the A or V pattern and produces no substantial postoperative torsional symptoms or substantial measured torsion at both distance and near fixation.

Humans↗
PubMed1977

Adjustable rectus muscle recession surgery. A follow-up study.

Fifty-six patients underwent an adjustable rectus muscle recession procedure. This procedure permits the surgeon to enhance or diminish the amount of muscle recession on the evening after surgery or the first postoperative day if cover-testing indicates an inappropriate amount of undercorrection or overcorrection. The adjustable rectus muscle recession technique seems to be a practical and effective means to change the strabismic deviation postoperatively. The procedure requires patient cooperation and is most suitable for patients age 15 years and older. The procedure has been effective in altering the angle of deviation, and this alteration has been stable during the follow-up period in most cases. In this initial series, the reoperation rate was low, postoperative alignment was excellent, and complications were minimal.

Adolescent↗
PubMed1976

Saccadic velocity measurements in internuclear ophthalmoplegia.

Five patients with internuclear ophthalmoplegia had horizontal saccades measured by electro-oculography. In all patients, abduction saccadic velocities were normal while adduction saccades were slowed either binocularly or monocularly. In one patient, adduction saccades were reduced in velocity, even though full adduction was present. Saccadic velocity measurements may be helpful in diagnosing internuclear ophthalmoplegia, especially in the early or subclinical case. As bilateral internuclear ophthalmoplegia frequently suggests multiple sclerosis, prolonged examination with more sophisticated and difficult diagnostic tests is avoided.

Electrooculography↗