[The use of small computers in ophthalmology].
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Biomedical subjects
Publications and source records attributed to M A Quere.
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This paper is the second part of a work devoted to the surgery of functional esotropias. The Authors bring a systematic study of fundamental motor impairments, and their particular management. Sucessively they consider the length, the alterations of contractible properties and the visco elastic changes of ocular muscles. Then they point out the partical means to reveal those troubles by clinical examination, electro-oculography, study of eye position during anesthesia and muscular traction test. They underline the advantages, limits and drawbacks of Fadenoperation. Theorically and practically, a too posterior scleral fastening is dangerous. To avoid some complications of Cupper's original technic, they use a personal procedure: the muscle slapping, which seems to give good results. Finally, they analyze central disorders. The electrooculographic recordings prove that motor troubles are certainly related with primitive visual impairments. They note that the frequent surgical cure means the muscle operations have a binding effect of proprioceptive nature on the central motor disorders.
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The surgical management of functional esotropias is now very different from some years ago with Fadenoperation settled by Cüppers. Indeed this procedure is the only one which can act in a fitted manner on muscular spasms responsible of more than 60% of convergent squints. The simultaneous using of classical technics remains necessary, but in very different way from the custom formely. In the first part of this work, the authors begin to analyze the mechenism of medical rectus recession, and they show that operation doesn't act by a modification in arc of contact as it was always said, but only by a muscular slacking. On the contrary the change in arc of contact is the main factor which intervenes in Fadenoperation, but the muscle exclusion has also an important part. Whereas the effects of Fadenoperation on adduction incomitance are perfectly clear, those on the deviation in primary position still remain very abstruse. A statistical report on 143 cases of operated blocking esotropias shows that often Fadenoperation alone does not bring a complete cure of motor troubles. The authors explain the reasons of these failures and point out the other accurate muscular actions which must be associated to obtain a good result.
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In two previous papers published in this journal, mechanic phenomena induced by the surgical procedures and the surgical management of fundamental troubles in esotropias were analyzed fully into details. In this third part, the authors explain the various pratical conclusions which result from their study. They underline that more than 60-70% convergent squints in children have a apastic component, and to overcome it classical procedures alone (resections and recessions) are fully unfitted. Equally, the Fadenoperation cannot by itself make away with motor disorders. Generally, the various technics must be associated to get cure. But to draw up an adequate surgical plan it is necessary to take into account the anaesthetic sign and the muscular traction test. The Authors have settled a pratical surgical scale allowing to know immediatly according to clinical and electro-oculographic findings, and the results to those tests, the particular operating actions which are convenient to do in each case and also their amount.
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Reckoning up the Balance-sheet of about 300 Faden-operations performed during two years in blocking convergent squints, the Authors note that whether this operation is absolutely appointed in various forms of horizontal incomitances in which the spasmodic factor is prevalent on the other hand in moderate forms it does not seem to give better results than classic muscular surgery. After having detailed the characteristics and technical difficulties of this operation, first they mention that its effects are unforeseeable in spite of a previous careful clinical examination; then moreover, it has a binding character. In many cases reoperations allowed to notice a considerable sclerosis of the formerly operated muscle and neighbouring capsule. To avoid these drawbacks, instead of a muscular fastening, they make a retroequatorial strapping on the sclera. They describe the successive steps in their procedure, which appears having many benefits with regard to the original Faden-operation.
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