[Ophthalmological screening studies in newborn infants. German Ophthalmological Society].
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Female↗
Biomedical subjects
N Stärk
Publications and source records attributed to N Stärk.
[Retroequatorial myopexy combined with bimedial recession for near-distance disparity esotropia].
PURPOSE: In cases of esotropia combined with a high AC/A ratio, partly accommodative convergence excess or with nonaccommodative convergence excess, two methods of surgical therapy are possible: recession of the medial recti (Parks) and retroequatorial myopexy (Cüppers). Our aim was to answer the question whether retroequatorial myopexy alone and in combination with bimedial recession are appropriate methods of reducing the strabismic angle at near and distant fixation to values under 10 PD and near-distance disparity to less than 10 PD to form the basis for single binocular vision without bifocals. PATIENTS AND METHODS: Eighty-three patients, aged 2-14 years (39 boys and 44 girls), were included in the study: 37 children (group A) with early-onset near-distance esotropia of 14-48 PD for distance and 26-65 PD for near objects and 46 children (group B) with acquired near-distance esotropia of 8-45 PD for distance and 26-70 PD for near objects. Inclusion criteria were a near-distanced disparity of at least 10 PD (range 10-33 PD), a follow-up of at least 3 months (median 5 months, range 3-69 months), retinoscopy in cycloplegia and full refractive correction. The amount of conventional surgery was chiefly based on the distance angle of esotropia. The myopexy was placed 12, 13 and 14 mm behind the insertion of the medial rectus. RESULTS: In 73 of 83 patients (88%) we were able to reduce the strabismic angle for distance and near fixation to less than 10 PD and in 73 cases even under 5 PD. In 77 of 83 patients (93%) the near-distance disparity was reduced to less than 10 PD and in 72 patients (87%) even under 5 PD. Postoperatively, 9 children had bifocals, but 3 of them have meanwhile discarded them. Two cases were slightly ocvercorrected and 1 case undercorrected. Seventy children (84%) attained grade of binocularity. CONCLUSION: Retroequatorial myopexy (fadenoperation) alone and combined with bimedial recession is an effective procedure in treating esotropia with abnormal near-distance disparity.
Adolescent↗
[Threshold value retinopathy of prematurity. Visual outcome of 2-year-old children after cryocoagulation].
BACKGROUND: The results of the Cryo-ROP group showed that cryotherapy significantly reduces the rate of adverse morphological and functional outcome of eyes with threshold retinopathy of prematurity. Structural status and visual acuity of 48 eyes which consecutively underwent cryocoagulation in our hospital between 1990 and 1994 were examined at 2 years corrected gestational age. METHOD: Visual acuity and fundus morphology were examined by Teller acuity-cards test, retinoscopy, orthoptic status and fundus examination. A favourable grating acuity was defined as > or = 2.2 cy/degree, a favourable morphology as no pathological or mild findings at the level of the posterior pole or stage 4 a. RESULTS: Fifty-six % of cases reached a quantifiable grating acuity between 0.32 and 13.0 cy/degree, 42% reached a favourable functional outcome, and 69% of the eyes had a morphologically favourable outcome. Fifty-five % of the measurable eyes were myopic, and 29% had a high myopia > or = -6.0 D. 47% showed a heterotropia. CONCLUSIONS: Our results show a discrepancy between morphological and functional outcome. Especially for zone 1 eyes, cryocoagulation of the avascular retina does not seem to allow a favourable morphological and functional outcome.
Child, Preschool↗
Stereopsis after primary in-the-bag posterior chamber implantation in children.
PURPOSE: The purpose of this study was to evaluate visual acuity and binocular function after primary posterior chamber intraocular lens (IOL) implantation in children. PATIENTS AND METHODS: A retrospective chart review of 39 eyes of 31 children was performed. Fifteen eyes with traumatic, 17 with developmental, and 7 with congenital cataracts without any other ophthalmologic problems were examined before and after cataract surgery (irrigation/aspiration procedure with implantation of a posterior chamber IOL). Twelve eyes also received a posterior capsulorrhexis and anterior vitrectomy. The mean age at surgery was 6.9 +/- 3 years (range, 3-12 years). RESULTS: Twenty (51%) of 39 eyes achieved a best-corrected postoperative visual acuity of 20/40 or better (range, 20/200-20/20). The mean postoperative visual acuity was 20/40 in the traumatic and developmental cataract groups and 20/100 in the congenital cataract group. There was a positive correlation between cataract morphology and visual acuity (P<.05). Bilateral cataracts had a better postoperative visual acuity than unilateral cataracts (P <.005). Nineteen (70%) of 27 eyes in which no primary posterior capsulorrhexis had been performed had posterior capsule opacification. Stereopsis was found in 10 of the 31 patients: 43% of the traumatic cataract group, 30% of the developmental cataract group, and 14% of the congenital cataract group. CONCLUSIONS: After capsular bag-fixated IOL, visual acuity and binocular function in children older than 3 years were favorable and the complication rate, excluding posterior capsule opacification, was low.
Capsulorhexis↗
[Capsular sack-fixed IOL implantation in pediatric cataract. Visual prognosis and complications].
BACKGROUND: The aim of the study was to evaluate results of visual acuity and binocularity and complications after cataract surgery with primary capsular bag-fixated IOL implantation in children. MATERIALS AND METHODS: Thirty-three children [mean age (+/- SEM) 6.9 +/- 2.9 years, range 3-12 years] accounting for 43 eyes, were examined before and after surgery (15 traumatic, 19 developmental, and 9 congenital cataracts, of the latter two groups 9 unilateral and 19 bilateral cataracts). RESULTS: All eyes had a best corrected postoperative visual acuity of 0.5 +/- 0.05. The postoperative visual acuity of the traumatic cataracts was 0.6 +/- 0.07, of the developmental cataracts 0.5 +/- 0.07, and of the congenital cataracts 0.2 +/- 0.05. Of the 43 eyes, 17 (40%) showed a best corrected visual acuity of 0.5 or better. There was a positive correlation between morphology (lamellar versus subcapsular opacification) and visual acuity (0.7 +/- 0.07 versus 0.5 +/- 0.05; P < 0.05). Bilateral cataracts had a better postoperative visual acuity than unilateral cataracts (0.7 +/- 0.07 versus 0.2 +/- 0.05 P< 0.001) Stereopis was found postoperatively in 62% of the children. In one eye a capsular bag-fixated IOL implantation was not possible, and so the IOL was inserted in the sulcus. Four children presented with postoperative fibrin formation. Posterior capsule opacification occurred in 19% of the eyes in which a primary posterior capsulotomy had been performed. CONCLUSIONS: The prognosis of visual acuity and the results of stereopsis in children older than 3 years following capsular bag-fixated IOL implantation are very good. Both the intraoperative and postoperative complication rates were low.
Cataract↗
[Refractive errors and strabismus in premature infants].
AIM: We aimed to investigate the incidence of refractive errors and strabismus in premature infants relative to their individual birth weight. METHODS: We investigated 107 premature infants with birth weight < 1250 g (group A, n = 54) and > 1250 g (group B, n = 53). All children were evaluated at the ages of 6 and 24 months for their spherical equivalent and the presence of high myopia (< or = 6.0 D) and strabismus. RESULTS: At 6 months the spherical equivalent was -0.93 +/- 4.2 D in group A and 1.09 +/- 1.9 D in group B, at 24 months -0.75 +/- 5.0 D vs 1.44 +/- 1.9 D (P < 0.01). At 6 months the incidence of high myopia was 10% in group A and 0% in group B, at 2 years 12% vs 2% (P < 0.01). Low birth weight and a long period of artificial ventilation correlated with the development of high myopia. At 6 months 21% of group A and 8.5% of group B showed strabismus, at 2 years 25% vs. 8.5% (P < 0.01). CONCLUSION: Because of the increased incidence of high myopia and strabismus we recommend routine retinoscopy and orthoptic evaluation at the age of 6 months in every child weighing less than 1250 g at birth.
Birth Weight↗
[Amblyopia, refractive errors and strabismus in congenital ptosis].
The incidence of amblyopia in the normal population is 2-6%, whereas among patients with congenital ptosis it can be as high as 50%. We reviewed 146 cases of congenital ptosis in patients aged between 5 months and 15 years and compared them to a control group of 34 age- and sex-matched patients. In 78 children (156 eyes) reliable optotype visual acuity could be obtained. Fifty-three eyes (34%) were amblyopic. Ametropia was responsible for 34% and anisometropia for 28.3% of the amblyopia cases. In 25.4% of cases strabismus, and in 11.34% stimulus deprivation, was the reason for the development of amblyopia. Children with congenital ptosis should have retinoscopy done in cycloplegia, and refractive errors should be corrected early. Controlled patching therapy should also be started early. Since stimulus deprivation amblyopia is rare, congenital ptosis need not be corrected early in life.
Amblyopia↗
Improvement of visual acuity after surgery for nystagmus.
PURPOSE: The authors compared the preoperative and postoperative binocular visual acuities and eye movement recordings of patients who underwent eye muscle surgery consisting of the Anderson-Kestenbaum procedure or the artificial divergence procedure modeled after Cüppers, or a combination of both procedures, for the treatment of infantile nystagmus with head turn. METHODS: Binocular visual acuities and eye movement recordings by electro-oculography (EOG) were compared preoperatively with those done within 3 weeks postoperatively. Shifting and broadening of the minimal intensity zone and foveation time and changing of the waveform were measured. The treatment of 6 of 18 patients was based on the artificial divergence principle; for 7 patients, treatment was in accordance with the Anderson-Kestenbaum principle; and 5 patients had combined procedures. RESULTS: The improvement in binocular visual acuities was two Snellen lines or more in one of six patients in the artificial divergence group and four of five patients in the combined treatment group. The EOG recordings showed shifting of the minimal intensity zone toward the primary position in all three groups. A broadening of the minimal intensity zone occurred mostly in the artificial divergence and combined groups. Increases in foveation time and changes in waveforms from jerk to jerk with foveation were found in three of six patients in the artificial divergence group and in two of five patients in the combined group. CONCLUSION: With less muscle surgery, the artificial divergence and combined operations gave better vision improvement than the Anderson-Kestenbaum operation.
Adolescent↗
[Surgery of Tenon's capsule in squint operations].
There is a good chance to reduce the scaring between conjunctiva, Tenon's capsule, muscle and sclera after surgical treatment of rectus and oblique muscles if a careful reconstruction of Tenon's capsule is made. In the rare cases that you have to reoperate, you will experience the benefit of these additional stitches (7-0 vicryl) that restore the integrity of Tenon.
Humans↗
[Tenotomy of the superior oblique muscle in treatment of A-pattern strabismus and Brown syndrome].
The superior oblique tenotomy and tenectomy is an very effective and predictable surgical method in correcting the A-pattern in strabismus when overaction of one or both superior oblique muscles is present. In this series of 42 patients with an A-pattern an average correction of 86 to 91% was obtained regardless of the degree of the A-pattern. So we didn't observe any case that was converted from an A- to a serious V-pattern as obviously a less reduction is obtained in lesser degrees of A-pattern. In 11 cases of true but atypical Brown's-syndrome the tenotomy of the superior oblique muscle had a very beneficial effect on the limited movement of the affected eye and a co-existing abnormal head posture.
Child↗
[Strabismus operations in adolescents and adults].
The present paper reports on 370 strabismic patients who underwent surgery after they had reached visual adulthood (ages 9-81). Surgery was performed for 183 exodeviations (50%), 139 esodeviations (37%) and 48 hypertropias. Patients desiring cosmetic improvement formed the largest group (172 cases, 46.5%). Most of these patients had been suffering from neglected concomitant heterotropias since childhood, but 17% attained subnormal binocular vision. To assess the risk of diplopia preoperatively, the deviation was fully corrected with prisms. Although intolerable persistent postoperative diplopia is a very rare event, the risk of this complication must be clearly pointed out to all visually adult patients. Apparently most adults, even those who have an anomalous retinal correspondence, respond as necessary to the new position of the eye and learn to ignore, suppress or fuse an initial postoperative diplopia. The best surgical results, in terms of restoration of binocular vision, were obtained in cases of intermittent exotropia and manifest exotropia without amblyopia.
Adolescent↗
[Pediatric ophthalmology: reasons for examination and disease pictures].
A representative sample of 800 patients was taken from 15,000 children treated between 1972 and 1984 in the Department of Pediatric Ophthalmology of Frankfurt University Eye Hospital. Their charts were reviewed to answer two questions: what are the most frequent reasons for ophthalmological examination in children under 15 years old and what are the most frequent diagnoses? Ophthalmological examinations were most frequently scheduled because of strabismus, errors of refraction and trauma or inflammation of the anterior segment, though also in a large number of cases because of general diseases, most often neurologic diseases such as epilepsy or elevated intracerebral pressure. The diseases diagnosed ophthalmologically were classified as congenital or acquired eye diseases and congenital or acquired general diseases with ocular symptoms. The most frequent are indicated in the text. Acquired diseases were more frequent than congenital diseases, though this group proved to be much larger in pediatric patients than in adult patients.
Adolescent↗
[Orbital involvement in neuroblastoma].
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Child, Preschool↗
[Refractive errors in visually handicapped children].
Aside from hereditary juvenile macular dystrophy (Stargardt's disease), the author observed a significant increase in the incidence of spheric and astigmatic refractive errors in a further six hereditary or congenital deformities with poor vision. A shift toward myopia was seen in cases of coloboma, both of the optic nerve head as well as of the macular region, and in cases of macular aplasia and hypoplasia. A shift toward hyperopia was found in complete and ocular albinism, in retinitis pigmentosa and congenital achromatopsia. This hyperopic shift is in contradiction to the hypothesis that myopia can be deprivation-induced. It is assumed that a disturbance of visual stimulation early in life can disrupt emmetropization and thus induce the eye to become either myopic or hyperopic, in combination with a high incidence of astigmatism. This disturbance of visual stimulation may be due to clouding of the dioptric media, though equally to congenital or hereditary defects in the retina or the visual pathways of visual cortex.
Adolescent↗
[Distance of muscle insertions in the corneal limbus].
During the last 3 years (1983 to 1985) accurate measurements of the distance between rectus muscle insertions and the corneal limbus were made on strabismus patients during surgery. After dissection of a muscle the distance from the posterior limbus (gray-white line) to the insertion line of the muscle was measured with calipers both at the midpoint and at each end of the insertion. A limbal incision was employed without exception. Statistical analysis was performed on a personal computer, using the Lotus 1-2-3 program. In contrast to the traditionally popular values determined by Fuchs, which are already over 100 years old (in parentheses), we found the following mean values: medial rectus insertion 4.5 mm (5.5), in 675 eyes operated on; inferior rectus insertion 5.67 mm (6.5), in 22 eyes operated on; lateral rectus insertion 6.20 mm (6.9), in 493 eyes operated on; and superior rectus insertion 6.64 (7.7), in 21 eyes operated on. The reasons for these differences are discussed. Because of the large size of the samples for the horizontal muscles it was possible to narrow down the confidence limits for the true mean values considerably; however, it is clear from the great differences between the lowest and highest values observed that the distance from the muscle insertions to the corneal limbus varies widely.
Adolescent↗
[Cryocoagulation of the retina in retinopathy of prematurity].
Of 246 systematically screened prematurely born infants, the majority with high neonatological risk, 12 developed a retinopathy of prematurity of at least Stage 3 according to the international classification of 1984, and underwent transconjunctival cryocoagulation. At a follow-up examination at age 6 months and later, there were no retinal changes apart from coagulation scars in 7 of the treated eyes; in 7 eyes slight connective tissue proliferations were seen (stage 1 cicatrization), in 4 eyes peripheral connective tissue proliferations with macula traction (stage 2 cicatrization), and stage 4 or 5 cicatrization in 2 eyes each. Five eyes were myopic, 2 of them severely so, and 4 eyes had a positive gamma angle. Unfavorable prognosis was indicated by a large avascular zone, preoperative stage 4, and early occurrence and rapid progression of retinopathic stages.
Cryosurgery↗
[Results of ptosis operations using silicone slings].
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Adolescent↗
[Indications for and surgical technic in congenital cataract].
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Age Factors↗