Biomedical subjects
Publications and source records attributed to T Baranowska-George.
The author shows the differences which have arisen between the methods for the last 35 years. The differences concern both the conservative and surgical treatments. Differences in the treatment of the squints in adults and infants in the first year of life are discussed. The author also presents discrepancies in the criteria of cure.
PURPOSE: Possibilities of application of localization method in the treatment of infantile strabismus in a very early period are presented. MATERIAL AND METHODS: The authors applied treatment with hypercorrective and compensating prisms in 17 children with infantile strabismus. The age of the children ranged from 0.5 to 5 years, mean age-1 year. All children were found to have no motility or limited motility of eyes toward the temples. Initially, the children's eyes were alternately occluded in prisms whose strength prevalently was 30-40 pr dptr before each eye, with base toward the temple. After 1-3 months motility of the eyes appeared. Next, glasses compensating the squint angle were worn, without covering the eyes, starting with 1/2 hour 3 times a day and gradually prolonging the wearing time. Hypercorrective prisms were further used with alternate occlusion of the eyes. RESULTS: In all children partial or complete correction of motility was achieved. Further treatment of strabismus followed the rules of the localization method.
The aim of this study was observation of influence of exercises with hypercorrective prisms on the behavior of vertical recti and oblique muscles. The study covered 182 persons with permanent strabismus (4 persons were operated early) and 8 children with accommodative strabismus. As treatment we applied exercises with hypercorrective prisms of 35 dioptres in front of each eye with the edge in direction of the biggest deviation of the eye. A full regression of the hyperfunction of muscles was noticed in 25 patients. The favourable changes were achieved in 38 patients. However the majority of patients were not doing the exercises systematically. Surely it is not the only reason of the lack of final beneficial result of exercises. The applied localization exercises with prismatic hypercorrection in hyperfunctions of vertical recti and oblique muscles gave beneficial result in form of regression of these hyperfunctions or reduction of the range of their deviation. There was also favorable influence on the regression of "residual" deviations of eye after operations. Application of such exercises in accommodative strabismus with hyperfunction of vertical recti and oblique muscles prevent from dissociation of binocular vision and genesis of permanent strabismus.
The aim of the work is to inspect the influence of the treatment by using hyper-correcting prisms on the vertical deviations of the eyes and on the head's position in persons with nystagmus. We observed 4 persons with nystagmus without strabismus and 3 persons with convergent squint. In persons without strabismus the prismatic correction placed with an edge in the direction of the "calm's zone" (quiet's zone) to obtain the straight position of the head when looking forwards was applied. Twice a day during 10 minutes the patients were making the movement's exercises in the vertical and horizontal direction looking by the prism separately by each eye. This prism (often 35 D prism) was placed with the edge in the direction of greater deviation of the oblique inferior muscles and the left rectus inferior muscle. Patients with convergent strabismus were treated according to the principles of localization method with consideration of the localize exercises by using hyper-correcting prisms in the vertical and horizontal directions. Two patients had a surgery in order to eliminate not aesthetic and strong prisms which were applied because of large horizontal squint. One patient with convergent alternate squint with hyperactivity of both inferior oblique muscles and inferior rectus muscle of the left eye was treated without surgery, only by the conservative treatment with prisms. In all patients we obtained a straight position of the head despite of the nystagmus still existing during the eyes movements in some directions. The treatment by using hyper-correcting prisms can completely replace the surgical treatment or is able to supplement it and prevent relapses.
PURPOSE: To check the behavior of the visual manual localization (v.m.l.) in the horizontal plane which can represent the state of the cortical connections between visual occipital centers and motor centers for the hand movement. MATERIAL AND METHODS: The examinations were performed using the manual localizer. The authors examined 14 patients with vertical deviations of the eyes caused by hyperfunction of the oblique inferior muscles and rectus inferior muscle in the left eye. V.m.l. examined both without the test and with the provoking test were in the range of the physiological norm which excludes the organic changes in the central nervous system. RESULTS: The authors suggest that the reason of the vertical deviations of the eyes is not localized in the higher parts of the nervous system but probably depends on unequal development of the connections in the nuclei of the oculomotor nerves.
Part I contains a description of treating amblyopia and strabismus since the XVIth century. The author deals with the gradual development of ophthalmology with regard to the modes of investigations, which automatically influenced the evolution of strabology. The description covers the development of German, English and French strabology concerning the treatment of binocular vision by means of synoptophore, and also the treatment of amblyopia by Bangerter and Cüppers's method, as well as penalization. The author discusses the significance of evaluating the binolcular vision state by tests in free space, besides the synoptophore ones. At the end the author reaches the conclusion that, over such a long period of time, there have been trends of resorting to certain methods, e.g. Bangerter and Cüppers's, penalization. These methods were gradually discarded by many strabologists, and at present time something like a comeback to surgical treatment is observed. That recurrence was due to the fact that the conservative methods, being improperly used, failed to give any effects at all, or provided only temporary improvement. The author emphasizes that the most serious cause responsible for the lack of any progress in the world strabology is that the cortical processes in the squint are not fully understood and that the causes of squint are constantly associated with the extraocular muscles.
The author presents an outline of strabology development in Poland since the 50s. Original ideas of Polish authors are provided, with three schools of treating strabismus existing in this country being discussed. In the final part the author highlights the differences between the method used in Szczecin and that in other centres implementing previous principles. The lack of consensus among the supporters of different methods is attributed to variability in the interpretation concerning the inception of mono- and binocular visual sensations, both in physiology and squinting subjects. The followers of the Szczecin School rely on Starkiewicz's theory which elucidates the genesis of the above-mentioned processes on the grounds of the reflex connections that arise between cortical centres of vision and all others in cerebral cortex, particularly with centres of kinetics and perception. Physicians proceeding with the treatment by old methods ascribe in these processes a great role to retinas of both eyes and ocular muscles without any explanation with regard to connections involving cerebral cortex.
The authors have examined 35 children aged between 6 and 13 years. They were children with convergent fixed squint (angle: from +4 degrees to +26 degrees) with convergent fixation. The patients were treated in accordance with the localizing method -stage II/III. Visual acuity of the master eye was equal 1.0, and of the squinting eye-from 0.3 to 0.8 after correction. Children were practising 2 x 7-10 minutes for 5 days on an apparatus modelled on the Starkiewicz alteroobturator, looking straight forward and with eyes alternatively covered. They had the binocular vision at long and short distance checked with the use of a test with coloured filters (TF), classical Bagolini test (Bki). In all patients the subjective test was positive. Among 35 examined cases the tests for binocular vision did not change in 17. In 16 patients the image seen with the squinting eye came close to the one seen with the master eye by the average of 2.6 degrees at long distance and 4.3 degrees at short distance. Improvement took place after first exercise (8 children) or after all five exercises (8 children).
The authors have examined the behaviour of functional scotomas in the squinting eye in children treated on the static apparatus modelled after the Starkiewicz alteroobturator. They examined 25 children at the age of between 8 and 14 years with convergent squint with macular fixation. Visual acuity of the master eye was equal 1.0 and in the of the squinting eye from 0.4 do 0.8 in correction. The angle of squint was equal from +4 degrees to +26 degrees. The patients were treated in accordance with the localization method-stage II/III. Children were practising on the apparatus 2 x 7-10 minutes for 5 days. In 12 children out of the 25 under examination the functional scotomas were of the same size after exercises, and in 12 children it decreased from 12% to 40%, on average 24.8%. In 1 child the functional scotoma absolutely disappeared.
Among 1455 examined babies aged 3 months the authors found a lack of normal fixation reflex in both eyes in 155 and in 52 in one eye only. In these eyes the parents applied 3 times a day an alternate occlusion of eyes or of the master eye only showing the babies interesting toys. After 2 weeks 83 babies showed normalization of fixation and after following 2 weeks of over described occlusion only 8 of them did not reveal a normal fixation reflex. These babies exhibited also a convergent squint. The pleoptic treatment by means of an euthyscope was installed, followed by normalization of the fixation reflex in 3. The rest of the patients was treated with spheroprismatic glasses by localization method.
The visual space-hand localization from each eye and by each hand was examined by means of a localizer. Two kinds of examination were performed: one checked the initial, the other the postexercise localization. The dominance of the cerebral hemispheres was determined by psychological tests. No dependence of the behaviour of the visual hand localization on the domination of a given hemisphere was shown.
The authors are continuing the work started last year and concerning the summing++ up of the results of treatment of the squint in adults according to a new classification. One hundred and sixty eight patients were subjected to the analysis; they were qualified to individual groups in dependence on the condition of their binocular vision. Six groups were separated: N--full effect, A--almost full effect, B--advanced, C--initial, D--vestigial and E--no effect. There was a larger percentage of persons effectively cured in the N-D groups in comparison with the previous year.
The diminution of the angles of squint is attained by localization exercises with hypercorrecting prisms and the straightening out of the angles by surgical procedures. The authors ++ analyzed the efficacy of the conservative and of the surgical treatment in the reduction of the deviation of the eyes in various groups of children in a different stage of cure. They stated that the best effect in the reduction of the squint may be achieved in the group of children with a good binocular vision (the group of almost full recovery) and the poorest effect--in the group of children without binocular vision.
Presented are the results of examination of 75 men, workers of the Chemical Works in Police, in whom in the scheme of complex clinical examinations detailed ophthalmological examinations have been carried out. The period of a professional contact with fluor amounted 6-15 years. The examined persons showed a variety of changes; the most important were opacities of the lens capsule, attenuation of the retinal arteries and a pathological record of the ERG.
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