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Biomedical subjects

W de Decker

Publications and source records attributed to W de Decker.

At least 19 recordsLinked to original sources
PubMed2006

[Acquired esotropia at advanced age].

BACKGROUND: Patients, most of whom are in their 8th decade of life, can suffer from a minimal acquired esotropia. They complain of blurred vision instead of diplopia due to their confusion. This is accompanied with the risk that the investigation covers only monocular disturbances. PATIENTS AND METHODS: Of 39 such patients, 22 underwent surgery while 10 were fitted with prisms. Another 3 recovered spontaneously and became, therefore, classified as VIth nerve palsies although no limitation of the abduction could be stated. Four patients refused any therapy, and 2 of them recovered in the course of many years. RESULTS: After 2 to 7 years, the individuals corrected with prisms were still compensated while within the operated cohort 3 had a recurrence after years. CONCLUSIONS: In almost all cases the prescription of separate glasses for distance with about 3 Delta base out on either side compensates the deviation for several years. In surgical units one finds a summation of chronically decompensated patients with obvious diplopia who need a bimedial recession. Lateral rectus resections are not appropriate as they lead to actual overabduction and final recurrence as well.

Age Factors↗
PubMed2003

[Prophylaxis of postoperative nausea and vomiting (PONV) in children undergoing strabismus surgery. Sevoflurane/N2O plus dimenhydrinate vs.propofol/remifentanil plus dimenhydrinate].

UNLABELLED: BACKGROUND AND STUDY GOALS: Strabismus surgery in children is frequently associated with a very high incidence of postoperative nausea and vomiting (PONV). In this study we investigated, whether TIVA is superior to inhalation anaesthesia concerning PONV when a prophylaxis using dimenhydrinate (diphenhydramine chlorotheophyllate) is administered in both groups. METHODS: 110 patients (3-10 years) were prospectively and randomly allocated to one of the following groups: Group TD (TIVA/dimenhydrinate; n= 55): anaesthesia was induced and maintained using remifentanil and propofol in common clinical dosages. Patients were ventilated with 30% O(2) in air. Group VD (Volatile/ dimenhydrinate; n= 55): anaesthesia was induced and maintained with sevoflurane in common clinical concentrations together with N(2)O in 30% O(2). All patients received dimenhydrinate 1 mg.kg(-1) i.v. after induction. PONV was recorded within the first 24 h postoperatively. The chi-square test and a multivariate analysis were used for statistical analysis. RESULTS: 52 patients of group TD and 54 of group VD were analysed. There was a trend in the incidence of postoperative nausea (PN): group TD 17%, 95% CI: 8-30%) compared to group VD 31%, 95% CI: 20-46%), p = 0.09. No difference was seen for PV and PONV: 21% (95% CI: 11-35%) in group TD vs. 35% (95% CI: 23-49%) in group VD, p = 0.109. These non-significant results can be easily attributed to the lack of power about 30%) of this study. According to the results of the multivariate analysis volatile anaesthesia was identified as an independent risk factor for PONV (OR: 2.92, 95% CI: 1.02-8.36). Other variables that were found to be an independent risk factor included history of PONV (OR: 8.19, 95% CI: 1.84-36.43), surgery lasting longer than 30 min (OR: 5.89, 95% CI: 1.82-19.82) and "Faden-operations" (retroequatorial myopexy) (OR: 5.48, 95% CI: 1.74-17.21). CONCLUSIONS: TD only showed a trend to lower PN incidences and no differences as for PV and PONV incidences, most likely due to a lack of power of this study. However, according to the results of the multivariate analysis, inhalation anaesthesia was shown to be an independent risk factor for PONV, as were history of PONV, surgery >30 min and "Faden-operations".

Anesthesia, Inhalation↗
PubMed2001

[The Titmus Fly Test--evaluation of subjective depth perception with a simple finger pointing trial. Clinical study of 73 patients and probands].

BACKGROUND: Subjects with different binocular defects were tested for their stereoscopic achievement. The determination of the subjects limiting disparity (in seconds of arc) was not used to characterize their stereoscopic acuity, but the subjective depth perception as a simple clinical method. METHODS: 52 subjects with different binocular defects and 21 normosensoric volunteers were examined for their stereoscopic achievement. In our stereoscopic measurement we ask the subjects to indicate the subjective plane of the fly's wings manually by their own finger, or by a hand-held plastic card, or with the aid of a mechanic instrument. The results of the different methods were compared with each other. RESULTS: There were no differences between the results within the group of normosensoric subjects. The patients with reduced abilities exhibit significantly different results in depth perception when measured manually or by machinery. The subjective depth localization correlates well with the binocular defect and is independent of the used stereoscopic method. CONCLUSIONS: The basic finger test of the subjective level of the Fly's wings gives a quite reasonable approximation of local stereoscopic depth perception. In terms of practical investigation the finger test shows in convincing manner whether the individual stereoscopic ability is based on normal, subnormal or anomalous binocular interaction.

Adolescent↗
PubMed2000

Persisting diplopia after bilateral laser in situ keratomileusis.

We present a case of persisting diplopia after bilateral laser in situ keratomileusis in a patient with high anisometropia and amblyopia. Treatment of this complication by ocular-muscle surgery was not possible because of missing fusion. We suggest that, especially in cases with anisometropia, a complete examination of binocularity be performed before refractive surgery.

Cornea↗
PubMed1999

Stereoacuity and aniseikonia after unilateral and bilateral implantation of the Array refractive multifocal intraocular lens.

PURPOSE: To evaluate stereoacuity and aniseikonia in eyes with unilateral and bilateral implantation of the Allergan Array refractive multifocal intraocular lens (MIOL). SETTING: Department of Ophthalmology, University Hospital, Kiel, Germany. METHODS: This study comprised 31 patients with a unilateral MIOL and a phakic fellow eye and 29 patients with bilateral MIOLs. In all pseudophakic eyes, an Array MIOL had been implanted between 1991 and 1994 during a prospective clinical trial. In the present study, patients were re-examined. Near and distance visual acuity were tested; binocular functions were assessed using Bagolini lenses, the Worth 4-dot test, the Lang random-dot test, and the Titmus fly chart. Aniseikonia was evaluated using Aulhorn's phase-difference haploscope. Mean follow-up was 43 months in both groups. RESULTS: After unilateral implantation 87.1% of patients and after bilateral implantation 93.1% of patients correctly perceived the stereograms of the Lang random-dot test. The mean subjective height of the measured Titmus fly was 4.2 cm after unilateral and 4.3 cm after bilateral implantation. The stereoacuity tests revealed no statistically significant differences between the groups. Distance and near aniseikonia were significantly less after bilateral than after unilateral implantation. CONCLUSION: Despite the simultaneous formation of multiple retinal images, the Array MIOL allowed good binocular vision including random-dot stereopsis. Functional aniseikonia developed but did not interfere with normal binocular vision.

Aged↗
PubMed1999

[Neglected constrained head posture in early childhood strabismus].

BACKGROUND: About 2% of the patients with an early-onset esotropia reveal a severe head tilt, of which about 80% tilt their head towards the side of the dominant eye. This is an abnormal posture without a profit for the patient, needing a torsional shift operation. A minority (20%) tilt to the side of the non-dominant eye, while presenting with a severe and unilaterally pronounced DVD. Once the DVD is really bilateral in terms of clinical aspects, patients have a tendency to give in preferring a consistent upgaze position. PATIENTS: Within 73 patients operated here for DVD (1995-1998) 19 showed the first and 10 the second here described head position. RESULTS: One of the first group (tilt) failed, while all the others had improvements of their postures, always to the degree of a socially acceptable appearance. CONCLUSION: A marked Faden operation on the superior rectus muscle of the elevating eye, occasionally bilaterally (in 2 cases of the upgaze-group) is a very rewarding procedure, much more than the "torsional Kestenbaum" in cases who tilt to the dominant side.

Adolescent↗
PubMed1998

[Improved fixation of unilateral suture operation of the rectus medialis muscle of the amblyopic eye].

BACKGROUND: Strabismus surgery influences the retinal fixation positively, as described by Böhme, Ehrich and Cüppers. Fadenoperation (Posterior Fixation) of the medial rectus muscle allows a more specific approach. It reduces the influence of overadduction and latent-type nystagmus on the retinal fixation, which becomes more central and more controlled after such an operation. PATIENTS: This effect is very marked in infants up to 2 years of age, but still significant in older children with intolerance for occlusion, and motility-dependent excentric fixation. About half of the 70 cases observed reached a useful fixation and acuity by "surgical pleoptics". With respect to the otherwise poor prognosis of these cases, this result can be regarded as favourable.

Amblyopia↗
PubMed1995

[Effect of traumatic iris defects on spatial perception].

Perforating injury to the eye often results in iris defects in addition to loss of the lens. To determine whether iris defects can impair stereopsis, we tested the stereoscopic vision of 23 patients treated at the University Eye Clinic in Kiel for perforating eye injuries involving the iris and, in most cases, the lens. The patients were divided into three groups according to the severity of the iris defect and the status of the intraocular lens. Individuals with strabismus or visual acuity < 0.5 (20/40) were excluded. Stereopsis was measured using conventional stereopsis tests (Titmus contour stereopsis, Lang global stereopsis) and by means of the Pulfrich pendulum phenomenon. Patients with traumatic aphakia without an iris defect (n = 33) served as controls. Optical rehabilitation was achieved in the controls lenses (n = 16) or intraocular lens implant (n = 17). In group I (intact lens, iris defect < 135 degrees), two of five patients had attained global stereopsis. In group II (implanted or contact lens, iris defect < 135 degrees), only one of the nine patients exhibited global stereopsis. In group III (no lens, iris defect > 135 degrees), none of the nine patients achieved global stereopsis. In the control group, by contrast, more than half of the patients with an implant (10 of 17) and 3 of 16 patients with a contact lens attained global stereopsis. The results indicate that severe iris defects are especially likely to impair stereoscopic vision, more so than traumatic loss of lens alone without an accompanying iris defect.

Adolescent↗
PubMed1990

[Visual acuity and binocular vision following surgery of extreme retinal detachment].

Retinal surgery with implantation of silicone oil was performed in 33 patients presenting with idiopathic or traumatic proliferative vitreoretinopathy. Following removal of the oil patients were on average followed-up for 6 to 29 months (14 months). Sixteen patients had had buckling procedures prior to endosurgery. Improvement of vision up to 4 rows of optotypes was noted in 21 patients following silicone oil removal. Three cases showed a large, organic, central scotoma. Ten patients suffered from diplopia; 3 of whom were known to have had a preexisting strabismus. Suppression of the visual impression of the operated eye was seen in 4 cases. Eye muscle surgery was necessary in 4 cases. Sixteen patients demonstrated normal binocular vision as far as possible taking the visual acuity into account.

Adolescent↗
PubMed1988

Unilateral medial rectus resection in the treatment of small-angle exodeviation.

Twenty-six patients with small-angle constant or intermittent exotropia of up to 7 degrees, and eight patients with small-angle exophoria of the convergence-insufficiency type, underwent unilateral medial rectus resection. Of the 34 patients, 9 were cured, 19 improved and in 6 surgery failed or there was early recurrence. Improvement occurred usually in patients who had basic microexotropia and in some who had homonymous abnormal retinal correspondence, a factor which limited the sensory results. The sensory, motor, and mechanical factors influencing the procedure are discussed in detail. The resection technique employed is reviewed, demonstrating the advantage of well-controlled results. This paper shows that resecting the medial recti is useful, not only in convergence insufficiency, but also in related small-angle exodeviations, for which a classification is proposed.

Adolescent↗
PubMed1988

[Torsional shift operation, a tool in complete early childhood strabismus].

By means of torsional shift operation, or "rotatory Kestenbaum procedure" - in which both ocular bulbs are rotated to the side to which the head is inclined - head malpostures can be eliminated or alleviated in three out of four cases. This applies both to the smaller group of patients with true nystagmus compensation as well as to the large group with "tilt" as a part-symptom of Lang's early-onset strabismus syndrome. The procedure for all four oblique muscles is described in detail, including the strategies for preventing side effects. The results of 98 operations are presented in tabular form. Additionally, the authors describe on the basis of case histories how to apply and modify the procedure when other typical, severe symptoms of early-onset strabismus syndrome require surgical correction. The discussion considers facts and hypotheses relating to the pathophysiological background.

Adolescent↗
PubMed1986

[The syndrome of enlarged orbits].

Combined orbital fractures cause hematomas and subsequent rigidity of the ligament apparatus around the inferior rectus muscles, while the few true blow-out fractures may lead to an adherence of connective tissues to the floor. The authors describe a third mechanism: Enlargement of the orbit impairs motility, especially the elevation of the globe: Diagnostic pressing of the orbital, parabulbar contents improves elevation. In 9 such cases that were free of the two other knows mechanisms motility was improved by reducing orbital volume. This was performed by implants (4 cases), by instillation of hydroxylapatite (4 cases) or by re-resection of the bony frame (1). Subsequent muscle surgery, if at all necessary, gave truly satisfactory results.

Collagen↗