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At least 793 records · Page 44Linked to original sources
PubMed1999

Benefits of stereolithography in orbital reconstruction.

OBJECTIVE: To describe the benefits of the stereolithography (SLA) modeling system in the evaluation and surgical planning of selected bony orbital pathology. DESIGN: Two case reports. PARTICIPANTS: One patient presented with a displaced left orbital roof fracture into his orbit causing globe compression and binocular vertical diplopia. A second patient underwent removal of his right orbital floor, medial wall, and inferior portion of his lateral wall during excision of a cylindrical cell papilloma of the paranasal sinuses. Postoperatively, he suffered from globe ptosis and binocular oblique diplopia. INTERVENTION: Stereolithographic models of the patients' orbits were obtained from computed tomography data to better assess the bony orbital pathology. In the second patient, the model was used as a template to create a temporary custom fit prosthesis to repair the defect of his orbital walls. RESULTS: The SLA models were useful in evaluating the dimensions of the bony defects and in preoperative surgical planning. Intraoperatively, the SLA models facilitated orbital surgical rehabilitation. Postoperatively, both patients noted resolution of their diplopia after reconstruction of more normal bony anatomy. CONCLUSIONS: In selected cases, SLA offers highly accurate models of the bony orbit for preoperative evaluation, surgical planning, and teaching and can act as a template for custom prosthesis manufacturing. This technology increases the orbital surgeon's options in managing complex orbital pathology.

Accidents, Traffic↗
PubMed2001

[Oculomotor paralysis and spinal anesthesia].

We describe a case of a parturient scheduled for Caesarean section in whom diplopia from abducens (sixth cranial) nerve palsy followed spinal anaesthesia performed with a 25 gauge Whitacre needle. After delivery, the patient experienced neckache, diplopia and postural headache successively. These symptoms were related to the dural puncture. Despite two consecutive epidural blood patches, no improvement of diplopia was observed. In 8 months, the nerve palsy had completely resolved.

Abducens Nerve Diseases↗
PubMed1995

Evaluation of results with three-point visualization of zygomaticomaxillary complex fractures.

OBJECTIVE: To retrospectively evaluate the results of three-point visualization and liberal rigid fixation for the treatment of unilateral zygomaticomaxillary fractures by assessing the incidence and severity of complications. STUDY DESIGN: Fourteen patients were examined an average of 19 months after 3-point visualization with multiple points of rigid fixation for their unilateral zygomaticomaxillary fractures. Patients were evaluated for asymmetry in globe position, superior tarsal fold size, diplopia, lateral canthus height, and malar projection. RESULTS: The following were found: two patients with significant changes in globe position, none with diplopia in direct gaze, two with diplopia in extreme gazes, two with severe tarsal fold asymmetry, five with mild tarsal fold asymmetry, and two with noticeable malar asymmetry. CONCLUSION: Three-point visualization and liberal rigid fixation for zygomaticomaxillary fracture treatment results in a low incidence of complications that are proportional in severity to the trauma sustained.

Adolescent↗
PubMed2003

Combined superior oblique tuck and adjustable suture recession of the ipsilateral superior rectus for long-standing superior oblique palsy.

PURPOSE: Unilateral long-standing superior oblique palsy may lead to superior rectus overaction/contracture requiring surgery of multiple extraocular muscles to correct the hypertropia. We review our technique of tucking the superior oblique combined with immediate postoperative adjustable suture recession of the ipsilateral superior rectus. METHODS: Twelve patients during the course of 2.5 years with longstanding vertical diplopia unrelated to closed head trauma or systemic disease who underwent our surgical technique were identified. The hypertropia in all patients was largest across the lower field (Knapp class 5) or nasal and lower fields (Knapp class 4). Outcome measures were primary-position hypertropia and vertical diplopia. RESULTS: The mean preoperative hypertropia in primary gaze measured 17.8 PD (range, 4 to 30). The mean 2-week postoperative vertical deviation was 1.3 PD (range, 4 PD hypotropic to 6 PD hypertrophic). The mean 6-week postoperative vertical deviation was 1.9 PD (range, 2 PD hypotropic to 12 PD hypertrophic). Diplopia in primary and down gaze, which was universally present before surgery, resolved in 11 of the 12 patients (92%). CONCLUSIONS: This combination of procedures appears to be a highly successful choice for treatment of unilateral long-standing superior oblique palsy. Advantages for both patient and surgeon include adequate exposure through a single conjunctival incision, elimination of risks to the contralateral eye, and immediate intraoperative suture adjustment of the ipsilateral superior rectus.

Adolescent↗
PubMed1989

Ophthalmic considerations in fronto-ethmoidal mucocoeles.

The pre- and post-operative ophthalmic consequences of fronto-ethmoidal mucocoeles are considered in a prospective series of 22 patients. Proptosis, lateral and inferior displacement, diplopia and restriction of ocular mobility were the commonest presenting problems. Following external fronto-ethmoidectomy, proptosis and displacement resolved completely in the majority of patients. One third of patients experienced a transient exacerbation of diplopia but this resolved in most patients. Persistent diplopia occurred in seven patients and required medical correction in four and surgery in one. This was due in all cases to underaction of the superior oblique muscle and probably to backward displacement of the trochlea which may be avoided by careful surgical re-attachment.

Adult↗
PubMed2002

High dose intravenous methylprednisolone pulse therapy versus oral prednisone for thyroid-associated ophthalmopathy.

PURPOSE: To compare the effectiveness of intravenous (i.v.) methylprednisolone pulse therapy and oral prednisone when used as the initial treatment of patients with mild or moderate thyroid-associated ophthalmopathy. METHODS: Thirty-three consecutive patients with thyroid-associated ophthalmopathy in Helsinki and Turku University Hospitals were randomly assigned either i.v. methylprednisolone pulse therapy (group A, n = 18) or oral prednisone (group B, n = 15). Treatment outcomes were measured by subjective changes in the grade of diplopia and quantitatively in several ophthalmic variables at 3 and 12 months. Any decision to proceed with additional treatment at 3 months was made on clinical grounds. The study was open in respect of both the initial treatment and the need for additional therapy. RESULTS: No significant differences in the grade of diplopia, proptosis or soft tissue activity scores were noted between groups A and B from 0 to 3 months. However, group A required additional forms of therapy at 3 months less frequently than did group B (p = 0.038). CONCLUSIONS: Our data suggest that i.v. methylprednisolone pulse therapy and oral prednisone are equally effective as initial treatments for thyroid-associated ophthalmopathy where diplopia, proptosis and signs of soft tissue inflammation are concerned. When additional treatment is required, i.v. methylprednisolone pulse therapy may be more effective than oral prednisone. However, the study's limitations meant that any decision to give additional treatment after the initial therapy was made on clinical grounds.

Administration, Oral↗
PubMed1993

Incidence of ocular motility problems following scleral buckling surgery.

The incidence and severity of extraocular muscle imbalance after conventional scleral buckling surgery was determined for 70 eyes of 68 patients with primary rhegmatogenous retinal detachment. Fifty-eight eyes had circumferential silicone explants, 10 eyes had radial sponges and 2 had both. Sixty-five per cent of eyes showed some restriction of ocular motility and 72% of patients had diplopia within their field of binocular single vision (BSV). The more extraocular muscles the explant was placed under, the more directions of gaze were likely to be restricted (p = 0.032). In 84% of eyes the restrictions could be related to the position of the explant. In 87% of patients their diplopia could also be related to the position of the explant. A second retinal detachment operation is more likely to cause restricted motility and more likely to cause diplopia within the expected field of BSV (p = 0.0297).

Adolescent↗
PubMed1998

Is eye padding routinely necessary after uncomplicated phacoemulsification?

PURPOSE: To investigate the value of eye padding following uncomplicated phacoemulsification under peribulbar anaesthesia. METHODS: A prospective randomised controlled study was conducted to compare the effect of a conventional eye pad and shield with that of a clear eye shield applied without a pad in 83 patients undergoing routine phacoemulsification under peribulbar anaesthesia without lid block. The primary outcome measures were corneal fluorescein staining, discomfort, diplopia and mobility. RESULTS: Moderate or severe corneal fluorescein staining on the first post-operative day was significantly more common in the pad and shield group (39%) than in the clear shield group (19%) (p < 0.01). There was no significant difference in post-operative pain as measured either by visual analogue scale or by categorical pain scale. Forty per cent of the clear shield group reported transient post-operative diplopia during the immediate post-operative period compared with 7% of the pad and shield group (p < 0.001). There was no significant difference in reported mobility between the two groups. CONCLUSIONS: Following phacoemulsification under peribulbar anaesthesia, the use of a gauze eye pad is associated with greater corneal fluorescein staining than a clear plastic shield without pad and offers no reduction in discomfort. A clear shield protects the globe against direct trauma, is associated with reduced moderate to severe corneal staining and facilitates vision in the early post-operative period. Transient diplopia reported by some patients given a clear shield is not disabling and would not be expected to occur in patients with one seeing eye. The use of a clear shield alone is a safe alternative to eye padding and offers important advantages in patients with one seeing eye.

Aged↗
PubMed2001

Active management in patients with ocular manifestations of myasthenia gravis.

PURPOSE: Myasthenia gravis can cause variable strabismus with disabling diplopia and/or poor cosmesis. A retrospective study of a group of patients with myasthenia gravis or 'myasthenia gravis like' syndromes was made. METHODS: The study group consisted of patients who had undergone botulinum toxin treatment and/or surgery for disabling diplopia, poor cosmesis or both. Surgical treatment was by conventional techniques including recess/resect, posterior fixation, superior oblique tenotomy and adjustable sutures. RESULTS: There were 9 patients in the study group (8 female, 1 male). Age at surgery ranged from 21 to 59 years (mean 46 years). Six were symptom-free following treatment. Two, although symptomatically improved, had occasional diplopia. One patient failed treatment and required an occlusive contact lens. CONCLUSIONS: The ocular manifestations of myasthenia gravis or 'myasthenia gravis like' syndromes may respond to surgery and/or botulinum toxin injection. Active intervention should be considered when deviations become stable. To our knowledge this is the first report of the use of botulinum toxin in such patients.

Adolescent↗
PubMed2004

A single transcutaneous injection with Botox for dysthyroid lid retraction.

PURPOSE: To evaluate the safety and efficacy of injections with botulinum toxin type A (BTTA,Botox), given transcutaneously, in the treatment of upper lid retraction associated with thyroid eye disease (TED). METHODS: A total of 15 patients (21 eyes) with a stable (TED) condition, and a euthyroid state, were enrolled into the study. There were 12 females and three males from ages 23 to 52 years. A single injection, at the centrally superior tarsal border transcutaneously, aiming at the levator aponeurosis and Müller muscle, was administered into each eyelid with 5-6 U of Botox. All patients were followed regularly for 4-6 months. Any complications, such as ptosis, diplopia, pain,or lid ecchymosis were recorded. RESULTS: All patients, except one, experienced much reduction of palpebral fissure. The mean difference of MRD1 between pre- and postinjections of Botox at the first week was -3.1 mm, and the effect remained, at least, for 2 months. There were temporary complications of ptosis in three patients and vertical diplopia in two patients, lasting 3-4 weeks. CONCLUSIONS: A single transcutaneous injection with Botox for the treatment of thyroid lid retraction is safe and effective. Some minor complications may occur, such as ptosis and diplopia; however, it may offer an alternative and temporary method for patients with dysthyroid lid retraction, who are waiting for a staged operation of either an orbital decompression or a strabismus surgery or both.

Adult↗
PubMed2005

Ocular motility findings in chronic progressive external ophthalmoplegia.

AIMS: To characterise the ocular motility features of chronic progressive external opthalmoplegia by quantitative and semiquantitative means. To assess the prevalence of diplopia and the binocular adaptations to nonaligned visual axes. METHOD: We studied 25 patients with chronic progressive external ophthalmoplegia. In each case muscle biopsies were consistent with mitochondrial myopathy. All patients underwent cover test in the primary position, assessment of binocular status, and measurement of uniocular fields of fixation using the Goldmann perimeter. RESULTS: A total of 23 (92%) patients had an exo-deviation, with six (26%) of those having an associated vertical deviation: 12 patients were binocular. Of the 13 patients with a manifest deviation seven had diplopia and six had suppression. Of all paired extra-ocular muscles (EOM), 68% had symmetry of movement within 5 degrees of each other. CONCLUSION: Almost all patients had an exo-deviation. Diplopia was more common than expected. The majority of patients had symmetry of EOM limitation.

Adult↗
PubMed2003

Follow-up study of treatment of orbital floor fractures: relation of clinical data and software-based CT-analysis.

This retrospective study quantifies isolated orbital floor fractures using software-based CT-analysis and compares the clinical outcome across surgical and non-surgical treatment groups. Depending on the surgeon's interpretation of the clinical and radiological appearance, 10 fractures were treated non-surgically and 20 fractures surgically, either with antral balloon catheter alone or in combination with an orbital implant. Ophthalmologic findings were evaluated until 12 weeks after injury. Fracture area, and volume of displaced tissue (VDT) were assessed by software-based CT-analysis. VDT was marginally significantly smaller in non-surgically than in surgically-treated patients (P=0.08). Ophthalmologic findings improved in all groups during follow-up and no statistical difference was found between the groups. Diplopia remained moderate in three patients with balloon catheter alone, and minimal in four patients in both surgical groups. In one patient with non-surgical treatment, diplopia remained minimal after 12 weeks. Although CT-analysis revealed no significant difference between both surgical groups, patients treated with balloon catheter alone presented more diplopia after 12 weeks. Using balloon catheters for fracture repair a combined approach should be performed when large fractures involve the orbital floor to achieve sufficient reduction of orbital content and placement of an orbital implant. Software-based CT-analysis is helpful for objective interpretation in managing of orbital fractures.

Adult↗
PubMed2004

Endoscopic transmaxillary reduction and balloon technique for blowout fractures of the orbital floor.

The indications for and timing of surgical treatment of blowout fractures of the orbital floor remain controversial. We report good results with the endoscopic transmaxillary reduction and balloon technique for blowout fractures of the orbital floor in the early stage after trauma in a consecutive series of 29 patients treated over the last 3 years, based on the following criteria: 1) diplopia observed by ophthalmological examination, 2) entrapment of intraorbital tissue at the fracture site on diagnostic imaging, mainly using CT scans, and 3) no improvement of diplopia during the acute phase (within one week of injury). Even in the presence of eyelid swelling, this method allows reduction and fixation of the fracture and impacted tissues simply and in a short time. Disappearance of diplopia was reported by 27 patients (93 %) within three months after surgery, and all 20 patients with enophthalmos were cured. There were only 4 cases with transient minor operative complications. Re-entrapment at the fracture site or relapse of symptoms was not seen during follow-up for 5 to 39 months (mean: 23.4 months). The combination of endoscopic transmaxillary reduction and the balloon technique for blowout fractures of the orbital floor is an effective and minimally invasive treatment with a high rate of improvement, not just for disturbances of ocular movement, but also for enophthalmos, which is often a problem in the long term.

Adolescent↗
PubMed1995

[Motility and binocular function after radial episcleral buckle].

BACKGROUND: The incidence of motility disturbances induced by episkleral buckle operations for retinal detachment has been reported to range between 7 and 77%. We anticipated a relation between the buckle size and the incidence and extent of motility disturbances. PATIENTS AND METHODS: We examined 45 patients 2 to 4 years after successful retinal detachment surgery with a radial buckle. The buckle diameter was 3-11 mm. Patients were examined for diplopia and heterophoria in the primary position and in 20 degrees secondary and tertiary gaze deviations. Stereopsis was determined using the TNO plates. Refractive error and visual acuity were also measured. RESULTS: Heterophoria measurements in the various directions of gaze revealed a hypermotility in 22/45 cases. A hypomotility was encountered only in one of the 45 cases. In 40 of the 45 cases the field of binocular single vision had a radius of at least 20 degrees. 39 of the 45 patients had stereopsis (after macular detachment 17/22, without macular detachment 22/23). 7/32 patients with a buckle of > or = 5 mm reported on diplopia, but none of the 13 patients with a buckle of < or = 4 mm. Heterotropia in the primary position was found in one of the 45 cases. He had three buckles, a 10.5 mm buckle under the superior rectus muscle of one eye and a 4 and 7.5 mm buckle under the inferior oblique and rectus muscles of the other eye. The resulting vertical deviation was successfully treated with prisms. Motility disturbances in the upper field of gaze were found in 2 of 45 cases with buckles of 5 and 7.5 mm. Diplopia was not permanent in these cases. DISCUSSION: Hypermotility towards the position of the buckle may be explained by a deviation of the adjacent rectus muscles, after sharp preparation and shrinkage of the intermuscular septum. CONCLUSION: Since motility disturbances were encountered only with buckles of > or = 5 mm, small buckles (< or = 4 mm) should be applied whenever possible.

Adult↗
PubMed1988

[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↗
PubMed1999

Botulinum toxin in childhood strabismus.

The use of botulinum toxin A (BTXA) in childhood strabismus is still a matter of debate. This study investigates the indications for and outcome of BTXA therapy in children at our institution. From 1985 to 1995, 237 children up to and including 16 years of age were treated with BTXA for strabismus. We undertook a retrospective study of 163 (69%) children from this group. Factors considered were age; anaesthesia; number of, indication for and outcome of injections; complications and follow-up. There were three major indications for the use of BTXA in children: firstly to improve binocular function, secondly as a post-operative diplopia test or for cosmetic reasons, and thirdly in the investigation or treatment of paralytic and restrictive strabismus. In the first group (54 children), BTXA produced improved binocular function in 54% of all patients treated and in 49% of those with a minimum follow-up of 12 months. In the second group (82 children), 88% showed informative post-operative diplopia tests and 44% had more than one injection to maintain improved cosmetic alignment. The third group comprised 27 children with a range of diagnoses, including 1 third nerve paresis, 12 unilateral or bilateral sixth nerve pareses, 7 unilateral or bilateral Duane's syndromes, 5 lost or fibrosed muscles and 2 others. This group had a range of outcomes which are discussed in the text. BTXA is useful in the treatment of a select group of children with strabismus. If there is evidence of threatened or recently lost binocularity, or risk of creating or worsening diplopia after surgery, it is a useful therapeutic tool. In children with strabismus of unusual cause it has diagnostic value.

Adolescent↗
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↗
PubMed2002

Role of magnetic resonance imaging in the assessment of disease activity in thyroid-associated ophthalmopathy.

Two different phases in disease activity are observed during the clinical course of thyroid-associated ophthalmopathy (TAO). The assessment of disease activity is important for predicting the outcome of medical management because medical treatment can be effective in the active stage. The aim of this study was to investigate whether magnetic resonance imaging (MRI) could assess the disease activity in TAO. To investigate the relation between MRI-T2 signal intensity (SI) and extraocular muscle (EOM) size, 11 patients with TAO were evaluated. EOM sizes (enlargement, volume) were measured by MRI-T1 image. T2-SI of EOM was expressed as a percentage of temporal muscle. The reduction in T2-SI was significantly positively correlated with that of EOM enlargement after treatment. Additionally, T2-SI in pretreatment showed a significant correlation with reduction in EOM volume for therapeutic effect, which indicates T2-SI in pretreatment can be one of the reliable parameters for predicting the therapeutic outcome of treatment. To investigate whether MRI-T2 pattern could predict the reversibility of diplopia, 28 patients with Graves' disease with or without ophthalmopathy were evaluated. Patients with TAO with reversible diplopia showed an uniform T2 pattern in enlarged EOM. However, in patients with irreversible diplopia caused by the mechanical limitation of EOM, MRI-T2 image showed no uniformity with a partial appearance of low T2-SI. The partial low T2-SI may indicate the progress of inactive (fibrotic) change in EOM after active (inflammatory) change. In conclusion, MRI is a useful tool for detection not only of EOM enlargement, but also disease activity in TAO. MRI-T2 SI and pattern can predict the outcome of medical management in TAO.

Adult↗