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PubMed1988

[Near heterophoria with a description of the heterometer].

The examination of near heterophoria with a heterometer using a large series of test plates presented "free-sighted" (i.e., not hindered by optical or mechanical means) enables a more comprehensive analysis to be made than has so far been achieved with other instruments. The principal components of the instruments are an angle mirror and various test panels. The selection of test panels currently available should be developed further. However, comparison with other instruments for examining near heterophoria justifies the conclusion that heterophoria or nearsightedness due to errors of refraction can be determined more easily with this instrument and hence treated more appropriately. Results of examination with the heterometer, combined with exhaustive application of comprehensive analytical test procedures, will probably help to extend our knowledge of the control sequence of binocular coordination in near vision. The instrument has already proved its value not only in orthoptic departments, clinics, and ophthalmologists' offices, but also for determining refractive indices and for screening. It can therefore be recommended for the diagnosis of near heterophoria.

Convergence, Ocular↗
PubMed1982

[Amblyopia and refractive error in patients who suffered from eyelid haemangioma in early childhood].

15 patients with eyelid haemangioma in early childhood had been reevaluated concerning amblyopia and refractive error. There was myopia in 3 of 15 and astigmatism in 9 patients on the tumor side. Amblyopia could be found in all patients with astigmatism higher than 2 diopters, all myopic patients and all patients with localisation of the haemangioma in the lower eyelid. The lower incidence of myopia in our group is discussed In connection with the x-ray therapy which 10 of our patients underwent. It seems necessary in patients with lid haemangioma in early childhood to discover and correct a possible refractive error as soon as possible and in some cases to start orthoptic treatment.

Amblyopia↗
PubMed1982

[Squint operation in presbyopic patients].

Since it is well known that the eye musculature undergoes degenerative alterations in old age, the question arises whether squint operations are effective in presbyopic and elderly persons. Twenty-four patients with horizontal squint (average age 63 years) wanted the operation because of diplopia, asthenopia and, in a few cases, for cosmetic reasons; 5 patients were aphakic. The operation was successful in 20 cases. The principles of dosing the operation are essentially the same as for juvenile patients. However, specific difficulties in treating elderly patients arise from: (1) lack of accommodative convergence, as a result of which the squint angle difference between distance and near fixation is usually greater; (2) increasing rigidity of the eye muscles, which diminishes the range of fusion; as a result, the patient is unable spontaneously to compensate for minor squint deviations; (3) senile organic lesions of the bulbs further impair fusion. It is advisable to treat convergent squint by correcting the average deviation between distance and near fixation, preferably shortening the external recti. Cases of divergent squint should preferably be treated by correcting the smaller squint angle, with resection of the external recti. The older the patient is and the worse his fusion, the more precisely the operation has to be dosed. Orthoptic training helps in old patients too.

Age Factors↗
PubMed2000

Specific analysis in plasma and urine of 2,3-dinor-5, 6-dihydro-isoprostane F(2alpha)-III, a metabolite of isoprostane F(2alpha)-III and an oxidation product of gamma-linolenic acid.

F(2)-isoprostanes (iPs) are free radical-catalyzed isomers of prostaglandin F(2alpha). Circulating and urinary iPs have been used as indices of lipid peroxidation in vivo. Utilizing an (18)O-labeled homologous internal standard, we developed a gas chromatography/mass spectrometry assay for the 2,3-dinor-5,6-dihydro (dinor-dihydro) metabolite of iPF(2alpha)-III. Although urinary excretion of iPF(2alpha)-III reflects systemic lipid peroxidation, the metabolite is more abundant (median of 877 (range of 351-1831) versus 174 (range of 56-321) pg/mg of creatinine; p < 0.01) than the parent iP in urine and can be measured in plasma. Metabolite analysis may be preferable in plasma due to the abundance of arachidonic acid as a source of ex vivo lipid peroxidation. Also, iPF(2alpha)-III may be formed in blood samples in a cyclooxygenase-dependent manner by platelets ex vivo. By contrast, the metabolite is not formed by aggregated platelets (0.71 +/- 0.08 versus 0.65 +/- 0.09 pg/ml). Although the metabolite/parent ratio is altered in cirrhosis, urinary dinor-dihydro-iPF(2alpha)-III is elevated and increases further during reperfusion following orthoptic liver transplantation. In addition to its formation as an iPF(2) metabolite, analysis of gamma-linolenic acid autooxidation products and the compound present in freeze-thawed plasma suggests that gamma-linolenic acid may also be an important source of dinor-dihydro-iPF(2alpha)-III.

Adult↗
PubMed2001

Methylprednisolone pulse therapy for patients with dysthyroid optic neuropathy.

purpose 1) To test the short- and long-term efficacy of Methylprednisolone Pulse Therapy (MPT) for patients with Dysthyroid Optic Neuropathy (DON). 2) To assess possible side-effects of MPT. 3) To assess whether a delay in decompressive surgery would influence the visual outcome. study design Retrospective, uncontrolled. method The records of 62 consecutive patients with DON, who received MPT between 1994 and 2000, were evaluated with special attention for pre- and post treatment ophthalmic and orthoptic parameters, Clinical Activity Score (CAS), visual fields and visual evoked potentials, and treatment complications. DON-patients were hospitalized and received four times 500 mg methylprednisolone intravenously. Immediately afterwards they were treated with oral prednisone (maximal dose 60 mg) and/or orbital irradiation (10 times 2 Gy). Evaluation was done one day after the last bolus (T1) and when the orbitopathy had been stable for at least six months (T2). results Visual acuity, proptosis, elevation and CAS all improved significantly at T1, whereas the lid aperture did not change. At T2, 24 out 62 (39%) DON-patients were stable with normal vision. The other 38 (61%) had undergone orbital decompression because of persistent or recurrent DON within one week to six months after MPT. Final visual acuity in the whole group (121 eyes) was less than 0.1 in 3 eyes, between 0.1 and 0.5 in 17 and more than 0.5 in 101 eyes. Treatment complications were: pylorus ulcer (n = 1), increased osteoporosis (n = 1), abcess formation (n = 1), and increase in insulin dosage (n = 1). conclusions 1) MPT is efficious as emergency treatment. 2) One-third of DON-patients are spared decompressive surgery. 3) MPT causes only rare and no serious side-effects. 4) The final visual outcome after MPT and orbital decompression is comparable to the results of immediate decompression.

Journal Article↗
PubMed2002

The history of research into the disorders of reading and accommodation in strabismic amblyopia.

During the past 150 years, research on amblyopia and nystagmus has developed in five different waves (W1-W5). Amblyopia was initially regarded to be enigmatic and believed to be related to eccentric fixation (W1, after 1850); later, it was ascribed to disorders in refraction or accommodation (W2, around 1900). After 1900 (W3), phylogenetic explanations appeared, and after 1945 (W4) concepts based on successful orthoptic practice came to the fore. Since 1965 (W5), research on amblyopia has been guided by modern insights into neuroanatomy and neurophysiology. In contrast to amblyopia, nystagmus has always been a well-defined symptomatic entity. Even though amblyopia and nystagmus are both symptoms of strabismus, their understanding has therefore developed along different paths. In juvenile strabismus, defects in binocularity lead to monolateral amblyopia, while defects in contour vision lead to bilateral nystagmus. In the present paper, these five waves of amblyopia research are described in more detail, with particular attention to the concepts of adaptation, visual fields, and sensory and motor functions as related to disorders in reading and accommodation.

Accommodation, Ocular↗
PubMed2002

A test battery of child development for examining functional vision (ABCDEFV).

A battery of 22 tests is described, intended to give an integrated assessment of children's functional visual capacities between birth and four years of age. As well as sensory visual measures such as acuity, visual fields and stereopsis, the battery is intended to tap a range of perceptual, motor, spatial and cognitive aspects of visual function. Tests have been drawn from practice in ophthalmology and orthoptics, vision research, paediatric neurology, and developmental psychology to give an overall view of children's visual competences for guidance in diagnosis, further investigation, management and rehabilitation of children with developmental disorders. 'Core vision tests' require no motoric capacities beyond saccadic eye movements or linguistic skills and so assess basic visual capacities in children of any age. 'Additional tests' have age-specific requirements and are designed to pinpoint specific deficits in the perceptual, visuo-motor and spatio-cognitive domains. Normative data are reported on nine age groups between 0-6 weeks and 31-36 months, each including 32-43 typically developing children. Pass/fail criteria for each test are defined. These data allow the selection of a subset of tests for each age group which are passed by at least 85% of normally developing children, and so are appropriate for defining normal development. The normalized battery has been applied to a range of at-risk and clinical groups. Aspects of children's visual performance are discussed in relation to neurobiological models of visual development.

Child Development↗
PubMed1998

Surgical repair of orbital fractures: how soon after trauma?

PURPOSE: To determine the results of surgical exploration soon after orbital trauma in comparison with surgery half a year or longer after trauma. METHODS: A retrospective study was done on 41 patients with motility disorders after trauma. Full ophthalmologic and orthoptic investigation was done in all patients. CT-scans and/or X-ray photographs were also made. The 41 patients were divided into two groups. One group of 13 patients did not need surgical repair. One group of 28 patients needed an operation. RESULTS: In 13 patients there was an orbital fracture but no surgical repair was needed. In 28 patients surgical repair was done. In 8 patients the operation was performed half a year or longer after trauma, 15 patients underwent surgery within two weeks after trauma, and 5 patients within two months. CONCLUSION: The best final results were obtained when the operation was done soon after trauma; however, the results in the patients who were operated late were fairly good too.

Journal Article↗
PubMed2005

The management of posterior polar cataract: the role of patching and grading.

BACKGROUND: The milder form of posterior polar cataract is often discovered late in preschool children if secondary symptoms like strabismus are not present. The question addressed in this paper is: do such children still profit from orthoptic and surgical treatment? PATIENTS AND METHODS: This was a retrospective study of the data from 13 patients, median age 4 years (range: 1 month to 12 years), with a mean follow-up of 4 years. Four changes to the red reflex were introduced. RESULTS: Surgery followed from two weeks to three years after starting occlusion therapy. Before therapy, the best visual acuity was 0.3 and the worst 0.06 (median 0.16). A median of four years after starting therapy, the visual acuity ranged from 0.9 to 0.4 (median 0.6). CONCLUSION: All milder cases profited from the treatment despite its late start. An earlier discovery would improve the prognosis. In any case, however, ophthalmologists should be encouraged to try patching before resorting to surgery.

Cataract↗
PubMed2006

Familial voluntary nystagmus.

PURPOSE: To examine the pathological significance and familial occurrence of voluntary nystagmus. PATIENTS AND METHODS: We examined two families orthoptically as well as with video and search-coil techniques or electronystagmography (ENG). Three members of three generations of the first family and a 9-year-old boy from a second family not related to the first were able to generate a voluntary horizontal nystagmus. RESULTS: The characteristics of the nystagmus of our original patient, his daughter and 8-year-old grandson (1st family) were remarkably similar: duration of 2-5 seconds, amplitudes of 1-4 degrees and frequencies around 15 cycles/second. In the second family, our patient with a congenital esotropia and hyperopia was the only one of his family who could voluntarily produce a nystagmus of about 5 degrees and 10 cycles/second for maximum of 20 seconds. During prolonged reading, the same nystagmus with disturbing oscillopsia developed involuntarily and was not suppressible. We added +0.75 diopters to both lenses of his spectacles to account for the result of our cycloplegic refraction. This stopped the involuntary nystagmus during near fixation. DISCUSSION: To avoid unintentional "bouts" of voluntary nystagmus, a reduction of the convergence impulse by plus-lenses may be effective. The parameters of voluntary nystagmus can be considered family-specific.

Aged↗
PubMed2006

Unaugmented vertical muscle transposition surgery for chronic sixth nerve paralysis.

INTRODUCTION: Chronic sixth nerve palsy can cause incapacitating diplopia requiring vertical muscle transposition surgery. Augmentation of surgery, with lateral fixation sutures, medial rectus recession or botulinum toxin injection, is associated with an increased risk of complications. PURPOSE: Our aim was to evaluate the efficacy and safety of unaugmented full-tendon vertical rectus transposition in chronic sixth nerve paralysis. METHODS: Longitudinal study of 21 patients with chronic sixth nerve paralysis of longer than 6 months duration, who underwent superior and inferior recti transposition surgery without medial rectus recession or botulinum toxin injection. Details of surgery, preoperative and postoperative examinations including full orthoptic examination were obtained from an electronic database. Outcomes included the change in angle of deviation, the requirement for further surgery to the medial rectus and postoperative improvement in diplopia. SPSS software (Version 12.0.1, SPSS Inc. Chicago, IL) was used to summarize baseline characteristics and outcomes and to compare preoperative and postoperative deviation (paired t-test). RESULTS: Twenty-one patients (10 (47.6%) men and 11 (52.4%) women) with a mean age of 41 years (range 4 to 74 years) were operated in the period between April 1998 and November 2000. Eighteen patients had unilateral and three had bilateral acquired sixth nerve palsy. Nineteen patients required unilateral surgery and two had bilateral transposition procedures. In patients with unilateral sixth nerve palsy, mean esotropia in primary position before surgery was 46.7 prism-diopters (PD) (95% CI 35.9-57.4 PD) and improved to 14.6 PD after surgery (95% CI 6.4-22.7 PD). The angle of deviation was significantly reduced by an average of 32.1 PD (p < 0.001, paired t-test; 95% CI 22.6-41.6 PD). Over all, 10 patients (55.6%) had a well-controlled esophoria with a postoperative alignment of within 10 PD of orthophoria without diplopia in the primary position, for distance and near. A further six patients (28.6%) required additional medial rectus recessions to achieve success. The only complication observed was slippage of the inferior rectus in one patient (4.2%), who consequently required further surgery. CONCLUSION: Botulinum toxin infiltration of the medial rectus in vertical rectus transposition surgery may be unnecessary, incurring cost, additional attendances and interventions for patients. Less than a third of all patients in our series required additional medial rectus recession later.

Abducens Nerve Diseases↗
PubMed2006

Ophthalmic manifestations of Sanjad-Sakati syndrome.

BACKGROUND: Sanjad-Sakati syndrome (SSS) is a rare disorder characterized by hypoparathyroidism, growth and developmental delay, and dysmorphism. The purpose of this report is to describe the ophthalmic manifestations of Sanjad-Sakati syndrome (SSS; hypoparathyroidism-mental retardation-dysmorphism syndrome, HRD) (OMIM 241410). PATIENTS: We included a total of 17 patients who were seen at two hospitals in Riyadh. METHODS: Each patient underwent a complete ophthalmologic evaluation including visual acuity assessment, orthoptic workup, slit-lamp biomicroscopy, intraocular pressure measurement, cycloplegic retinoscopy, funduscopy, corneal diameter, and axial length measurement. RESULTS: All 17 (100%) of the patients had normal visual acuity. All patients had microphthalmia with normal intraocular pressure. Eight (47%) of the patients had esotropia and four (23%) had exotropia. Ophthalmoscopy revealed tortuous retinal blood vessels in all patients. Hyperopic astigmatism was present in 16 (94%) patients. CONCLUSION: Patients with SSS display a variety of ocular findings including errors of refraction, strabismus, and retinal vascular tortuousity.

Adolescent↗
PubMed2006

Improving outcome in stroke patients with visual problems.

BACKGROUND: stroke is a common condition, frequently with significant effects on a patient's ability to live an active and independent life. Anything that may potentially have a beneficial effect on the rehabilitation of such patients should therefore be explored, and as ocular and visual problems are common in patients with stroke, it is important that their implications are understood. OBJECTIVE: this article aims at providing a broad overview of the literature relating to visual problems in stroke patients, looking particularly at the impact on, and the potential for, recovery and rehabilitation. METHODS: the online database PubMed was searched for literature relating to visual and ocular problems in stroke. The resulting abstracts and articles were then reviewed to extract clinically relevant information. Findings are summarised and discussed. CONCLUSIONS: visual problems in stroke are associated with problems with activities of daily living (ADL), falls and rehabilitation. Because many visual problems are easily corrected or improve with intervention, there may be a role for formal screening for visual problems in stroke patients in a rehabilitation setting. The orthoptist has an important role to play in stroke rehabilitation, and links between the stroke and orthoptic departments should be established in all units.

Humans↗
PubMed2006

Neurological features of congenital fibrosis of the extraocular muscles type 2 with mutations in PHOX2A.

Congenital fibrosis of the extraocular muscles type 2 (CFEOM2) is a complex strabismus syndrome that results from mutations in the homeodomain transcription factor PHOX2A. To define the clinical and neuroimaging features of patients with this autosomal recessive syndrome, we studied 15 patients with genetically defined CFEOM2. All patients underwent full neurological, neuro-ophthalmological and orthoptic assessments. Twelve patients had pupillary pharmacological testing and nine had 3.0 tesla MRI of the brain, brainstem and orbits. Patients were born with severe bilateral ptosis and exotropia with almost complete bilateral absence of adduction, elevation, depression and intorsion. Variable abduction was present prior to strabismus surgery in 14 patients, and central ocular motility reflexes (smooth pursuit, saccades, vestibulo-ocular reflex and optokinetic reflex) were intact except for convergence. Pupillary light and near reflexes were not present, but irises were anatomically normal and responded to pupillary pharmacology. Neuroimaging of brain and brainstem was remarkable for the anatomical absence of cranial nerve (CN) 3 and probably CN 4 bilaterally. Therefore, the CFEOM2 phenotype and neuroimaging are both consistent with the congenital absence of CNs 3 and 4. Additional features included presence of most central ocular motility reflexes, a central lack of pupillary responsiveness of uncertain aetiology and modest phenotypic variability that does not correlate with specific PHOX2A mutations. Clinical presentation, neuroimaging and Phox2a-/- animal models all support the concept that CFEOM2 is a primary neurogenic abnormality with secondary myopathic changes.

Adolescent↗
PubMed2003

Recombinant activated factor VII for the treatment of life-threatening haemorrhage.

To describe the use of recombinant activated factor VII (rFVIIa) in patients with life-threatening haemorrhage. We report a case series of Australian patients with life-threatening haemorrhage who were treated with rFVIIa prior to August 2002 namely 21 patients, median age 45 years (range 22-79 years), 33% (seven of 21) female. The major causes for bleeding were multi-trauma, cardiac or vascular surgery, or orthoptic liver transplantation. In the 24 h prior to the administration of rFVIIa, the median blood usage was 22 U packed cells (range 3-66 U), the median International Normalized Ratio was 1.6 (range 1.4-3.6) and the median activated partial thromboplastin time was 55 s (range 31-180 s). During the 24 h after administration of rFVIIa, the median blood usage was 2 U packed cells (range 0-16 U), the median International Normalized Ratio was 1.0 (range 0.9-1.2) and the median activated partial thromboplastin time was 40 s (range 30-94 s); P < 0.001 for each comparison. Sixteen of the 21 patients were discharged from hospital or were alive at 30 days. There were no thrombotic complications following the administration of rFVIIa. These uncontrolled data suggest a role for rFVIIa as an adjunctive haemostatic measure in surgical patients with life-threatening haemorrhage for whom conventional measures to achieve haemostasis have failed.

Adult↗
PubMed1998

Serious hemorrhage complicating diagnostic abdominal paracentesis.

We describe two patients awaiting orthoptic liver transplantation in whom diagnostic paracentesis for the diagnosis of spontaneous bacterial peritonitis led to major hemorrhage. Accordingly, we advise caution in patients such as ours, particularly if the prothrombin time or partial thromboplastin time is more than twice the control value.

Adolescent↗
PubMed1975

Evaluation of the status of binocularity in the non-strabismic and strabismic with regular and prolonged testing.

The need for "in-depth" study of the status of binocularity in true space of both the non-strabismic and strabismic before orthoptics is discussed. Vectogram tests to ascertain the status of binocularity of the non-strabismic and the strabismic are explained. With the strabismic, the Single Oblique Mirror Stereoscope is used and the tests with it are enumerated. Significant enhancement of diagnosis of the status of binocularity in the non-strabismic is obtained by testing over a prolonged period of time, instead of relying only upon tests based upon instantaneous response. Prolonged testing techniques utilizing Vectograms in which the patient used alternating saccadic, jump, oculo-rotary fusional movements from the straight ahead position into the lower reading field are used.

Asthenopia↗
PubMed1977

Phoria, vergence, and fixation disparity in oculomotor problems.

Measures of horizontal phoria, vergence, and fixation disparity were obtained for 2 samples: 28 optometry students without symptoms and 32 orthoptic patients with symptoms associated with binocular oculomotor difficulties. Discriminant analysis was used to determine which tests or group of tests best discriminated between the 2 samples. Analysis was done for both samples and for exophoric and esophoric subsamples. Sheard's criterion was the best discriminator for the exophoric group, and amount of heterophoria was the best discriminator for the esophoric group. Fixation disparity was the next best discriminator for both groups.

Accommodation, Ocular↗