Biomedical subjects
Publications and source records attributed to J L Mims.
I describe a system for ensuring the formation of true knots in the locking bites in strabismus surgery. I also present a method for teaching this system to residents that makes use of a piece of cotton or nylon rope, a cotton mop refill, and the end of a garden rake.
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Sixty-one children with bilateral overaction of the inferior oblique muscle with concurrent or previous infantile esotropia received bilateral inferior oblique recessions with anteriorization to a point 2 to 4 mm anterior to the lateral end of the inferior rectus insertion. Subsequent reoperation for recurrent overaction of the inferior obliques was needed in only one case. Also, substantial reduction in dissociated vertical deviation (DVD), when present, and almost complete absence of subsequent need for surgery for DVD among the 61 children of this series were new findings. Only one of the 61 required subsequent surgery for manifest DVD. In another series of 60 infantile esotropes of similar ages drawn from the same practice who had previously had no inferior oblique surgery, nine needed surgery for DVD. This difference (one of 61 vs nine of 60) was significant.
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We developed a mathematical model to predict the probable success rate of the first surgery to correct acquired esotropia with normal accommodative convergence-accommodation ratio in children. A computer-averaged dose-response curve of the effect of 68 bilateral medial rectus recessions was combined with various assumptions regarding likely errors in surgical performance and likely errors in measurement of the preoperative deviation. Fifteen different sets of reasonable assumptions were tested, giving a range of theoretical success rates from 72% to 96%. The results of this study clearly indicate that a certain proportion of failures is to be expected when this or other forms of strabismus are treated surgically by a fully competent ophthalmic surgeon performing as accurately as is practically possible.
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The fundus photographs and fluorescein angiograms of 255 consecutive cases of choroidal nevi were reviewed. Sixty-one cases (24%) were selected as suspicious on the basis of strict preestablished criteria including greatest single diameter, elevation, degree of disruption of the retinal pigment epithelium, and presence of subretinal fluid. Fifty of these 61 had adequate four-year follow-up. The remaining 194 cases, labeled as nonsuspicious, were usually small, relatively flat, slate-grey nevi which failed to meet the criteria for being suspicious. Of the 50 suspicious choroidal nevi followed four years, five (10%) showed photographic evidence of growth 4 to 30 months after the last examination. In contrast, none of the 194 nonsuspicious cases demonstrated growth. On the basis of these results, recommendations are made for the management of suspicious choroidal nevi.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.