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PubMed1992

[Should accommodative strabismus be operated on?].

Hypermetropia is probably not the real cause of accommodative squint. The arguments for this view are the absence of binocular vision in more than half and of the presence of a vertical deviation in about one third of cases of accommodative strabismus. Furthermore, after reduction of this vertical deviation by means of simultaneous surgery upon the horizontal and oblique muscles, binocular vision recovers spontaneously, the accommodative component of the squint disappears and visual acuity improves without glasses. Recent neurophysiologic research explains the beneficial effect of simultaneous surgery. According to these investigations there are two systems of accommodation and convergence; a quick phasic one, where accommodation is linked with convergence and a slow tonic one without interaction. The tonic system is responsible for the neutralization of the excess of convergence induced by hyperaccommodation. Tonic vergence depends on fixation disparity which is eliminated by a vertical deviation and restored by the surgical reduction of this vertical deviation. The fact of wearing positive correction produces and consolidates a hypo-accommodation, revealing a latent hypermetropia which could compromise emmetropisation. Furthermore, this correction being associated with squint, is a source of psychological complexes and the cost of an optical treatment is high, considering that spectacles need to be renewed frequently and many times during lifetime. On the other hand, simultaneous surgery removes an important obstacle to fusion and makes the patient independent of spectacles, not only regarding the squint, but also visual acuity.

Ethics, Medical↗
PubMed1959

Electromyography in strabismus.

Electromyography of the human extraocular muscles is a new research tool designed to elucidate many problems in ocular physiology. Although at present it affords little clinical help in the diagnosis and treatment of strabismus, it may in time be of value in neuro-ophthalmologic disease.

Electromyography↗
PubMed1992

Forming and teaching true knots for strabismus surgery.

I describe a system for ensuring the formation of true knots in the locking bites in strabismus surgery. I also present a method for teaching this system to residents that makes use of a piece of cotton or nylon rope, a cotton mop refill, and the end of a garden rake.

Humans↗
PubMedDate not supplied

[The role of accommodation in functional strabismus].

The accommodative reflex unleash is produced by many stimuli, of which the most important are the lack of clarity of the retinal image and the convergence. The ciliary muscles, although innervated by vegetative fibres, behave like striated fibres. It is also discussed the role of accommodation in the appearance of functional strabismus.

Accommodation, Ocular↗
PubMed2003

Major review: The underutilization of vision screening (for amblyopia, optical anomalies and strabismus) among preschool age children.

BACKGROUND: Nearly 80% of preschool age children never get an eye examination (1). Many "back to school" physical exams do not test for common vision disorders. Untreated eye and vision problems can interfere with most life experiences. The prevalence of undetected vision problems among preschool age children is estimated to be 5% to 10% (2). Failure to detect visual impairment early may have a permanent effect on long term vision outcomes, education achievement, and self esteem (3). The most common vision disorders among children are strabismus, amblyopia and optical problems impairing visual acuity and depth perception. Various professional organizations, including the American Academy of Pediatrics (AAP), advise preschool vision screening to detect and correct vision problems before school entry. The AAP also recommends that children continue to receive periodic eye and vision examinations throughout childhood. However, resources for this level of care are rarely available. As such, only 21% of preschool age children receive vision screening and even fewer children get a comprehensive eye examination (1). PURPOSE: The purpose of this review is to determine, through a critical review of the literature, the social, economic, and political barriers which contribute to the underutilization of vision screening among preschool age children. A secondary aim is to identify gaps in the literature base that may be needed to complete a public policy response to this problem. METHOD: A comprehensive review and analysis of the pertinent available literature. RESULTS: A variety of barriers exist which prevent children from receiving proper vision screening. They include social, economic and even political problems. Social contextual barriers include ignorance, inconvenience, language, and a lack of providers. Financial barriers affect low income families. Political barriers reside in the disproportionately meager funding of preventative medicine. Moreover there are additional factors which put preventative medicine for vision at a disadvantage compared to other pediatric demands like immunizations, such as the danger to both the individual and society from the medical condition being prevented. CONCLUSION: Even considering large gaps in the literature concerning this topic, it is clear that low income, minority, uninsured families are at high risk of not utilizing vision screening. Ignorance remains a major problem at all levels so improvements in the distribution of information and education are needed and should yield improvement. Additional funding is necessary to pay for these remedies. Titration and direction of available resources to those at highest risk will create the greatest return on such efforts.

Amblyopia↗
PubMed1992

The reliability of adjustment in strabismus surgery.

It has been recommended that the position of the operated muscles be adjusted shortly after strabismus surgery to achieve better alignment on the first postoperative day and thereby ensure satisfactory later alignment. We compared prism cover test measurements on the first postoperative day with measurements within the first few months after surgery to determine whether day 1 measurements remained stable or whether they changed significantly, providing an inaccurate basis for adjustment. Our study found a fairly large variability in the deviation between the first and last day of the study. Eighteen percent of patients varied by 5 to 9D, and 49% differed by > 10D or more. Equally important was the finding that, had an adjustment been made, it would have made the final result worse than without adjustment. Both of these factors would seem to indicate a degree of variability that controverts the predictability of the adjustment procedure.

Adolescent↗
PubMed2003

[The surgical results of correcting strabismus with inferior oblique hyperfunction].

PURPOSE: To evaluate the surgical results of correcting strabismus with inferior oblique hyperfunction. MATERIAL AND METHODS: A retrospective chart review of 40 patients, who underwent surgery from 1999-2001 was performed. 7 patients had isolated inferior oblique hyperfunction, 5 with hypertropia, 23 patients had esotropia with inferior oblique hyperfunction and 5 patients had exotropia with inferior oblique hyperfunction. The recession of inferior oblique muscle was undergone in cases with inferior oblique hyperfunction, sometimes in hypertropia with anteposito. The recession-resection of rectus muscles with myotomy-tenotomy of inferior oblique muscle or his recession usually were performed in cases with coexisting esotropia or exotropia. RESULTS: In all cases eyes were acceptably aligned. The recession of inferior oblique muscle is the most effective method of operation in high oblique hyperfunction.

Child↗
PubMed2004

[Botulinum toxin A in the treatment of concomitant strabismus in children].

PURPOSE: To evaluate the results of treatment of esotropia, exotropia and hypertropia with botulinum toxin A. MATERIAL AND METHODS: 72 children with esotropia, exotropia and hypertropia treated with intramuscular injection of botulinum toxin A. RESULTS: Squint angle decreased 76% in children with alternant esotropia, 70% in children with monocular esotropia, 64% in alternant exotropia and 54% in monocular exotropia after treatment with botulinum toxin A. In hypertropia squint angle reduced in 50%. CONCLUSIONS: The use of injections of botulinum toxin A in treatment of concomitant strabismus improves position of eyes, which creates better conditions for development of localization with normal retinal correspondence.

Botulinum Toxins, Type A↗
PubMed1978

[Types of occlusion in the treatment of convergent strabismus].

The different kinds of penalizations which are used in strabismus therapy--occlusion, atropine penalization, optic penalization, filters, partial occlusion of the glasses (sectors)--are being discussed with their advantages and disadvantages. Their indications and their results are reported according to the age of the child and the degree of the amblyopia.

Amblyopia↗
PubMed2004

[Interhemispheric connections of areas 17 and 18 in the cortical columns of cats with unilateral strabismus].

The interhemispheric connections of areas 17 and 18 of the cerebral cortex were investigated in cats with experimental unilateral strabismus. Single cortical columns were microiontophoretically injected with horseradish peroxidase, and retrogradelly labeled cells were demonstrated in the opposite brain hemisphere. After tracer injection in area 18 columns, the labeled callosal cells were located in area 17/18 transitional zone, similar to what was found in normal cats. However, in some cases the expansion of the region of callosally labeled cells distribution, was found. It is proposed that the extent of the region of callosally-connected cells may vary depending on whether the cells receive their input from intact or strabismic eye.

Animals↗
PubMed1992

Reduction of postoperative adhesions secondary to strabismus surgery in rabbits.

The efficacy of tissue coating with sodium hyaluronate solution or oxidized regenerated cellulose (Interceed) sleeves in reducing the occurrence and severity of postoperative adhesions following strabismus surgery was tested in rabbits in vivo and compared with the efficacy in this regard of treatment with balanced salt solution. The use of Interceed sleeves significantly increased formation of postoperative adhesions, but coating with sodium hyaluronate solution prior to and during surgery significantly reduced such formation.

Animals↗
PubMed1979

[Surgical management of divergent strabismus (author's transl)].

This study, about 111 cases of exodeviations, establishes a guideline for surgical management of divergent strabismus. First the main points of the clinical examination, and the different classifications of the exodeviations are exposed. Then the technics of surgical treatment are defined, with or without pre or post surgical orthoptic treatment. The conclusions are as following: -- some clinical elements guide our treatment: the refraction, the age at onset, the study of the deviation after constant use of prisms, the existence of A or V syndrome. -- The main points of the surgical management are: the age of surgery, the choice of technic (symmetrical or not), the usefulness of a transient overcorrection, and above all the quantative rules for the surgical treatment. So it as been possible to stress the functional result is quite depending on the clinical type of exodeviation.

Age Factors↗
PubMedDate not supplied

[Results of the use of a modified diploptic method for recovery of bifixation reflex in the treatment of concomitant strabismus in children].

Exercises with changing distance between the eye and the test object, modified by the author, were used in the treatment of 75 children with strabismus after orthotropia was detected in them, in order to restore normal binocular vision that may be preserved if examined from various distances. After the treatment the frequency of recovered binocular vision at long and short distances was found the same.

Adolescent↗
PubMedDate not supplied

[Clinical presentation, diagnosis and treatment of strabismus combined with ptosis].

On the basis of examination of 172 patients with strabismus concomitant with ptosis, different clinical forms of the former were defined and their clinical variations were classified. Symptomatology was described for each form. An independent type of false positive ptosis was pointed out. The notion of "positive and negative fixation tests" was introduced. A proper interpretation of the origin of true and false ptosis was presented. Finally, a sequence and tactics of surgical and functional treatment of different clinical presentations of squint concomitant with ptosis are lain down.

Adolescent↗
PubMed1992

Incidence of inadvertent perforation in strabismus surgery.

We conducted a prospective study for over 2 years to determine the incidence of perforations following strabismus surgery. All eyes were examined by indirect ophthalmoscopy and indentation immediately after surgery in an attempt to identify perforation sites. No cryotherapy or treatment was done. None of the 10 perforations identified was associated with retinal detachment or endophthalmitis. The incidence of perforations was 2.8% on a per-case basis and under 1% on a per-muscle basis.

Adolescent↗
PubMed2005

[Clinical features of V patterns strabismus and its long-term effect of surgical treatment].

OBJECTIVE: To investigate the features and treatment of V patterns strabismus. METHODS: Pre- and post-operative deviation and oblique muscle action as well as binocular visual function were evaluated in sixty-three V pattern patients. The difference between upgaze and downgaze of deviation were recorded before and after operation. RESULTS: Sixty-two patients (98.4%) with binocular or unilateral inferior oblique overaction + 2 to + 3 were treated with inferior oblique weakening procedure and horizontal rectus recession-resection procedure. 1 patient with binocular inferior oblique overaction + 1 treated with horizontal recti recession-resection procedure. The difference between upgaze and downgaze is 25.6 prism diopters (PD) preoperatively and 4.5 PD postoperatively. The primary-position exotropia preoperatively of 48 V pattern exotropia is 37.2 PD, after surgery, the average deviation is 3.4 PD of esotropia [38 cases (79.2%) with deviation within +/- 10 PD]. 15 cases of V pattern esotropia had deviation 50.6 PD preoperatively, after surgery, the average deviation is 2.4 PD of esotropia [11 cases (73.3%) with deviation within 10 PD]. 21 patients (33.3%) obtained stereo visual function after surgery. CONCLUSION: V patterns always had inferior oblique over action and could be treated with the inferior oblique weakening procedure. The primary-position deviation should be treated by traditional horizontal rectus recession-resection procedure. The stereoscopic function had a good prognosis with surgery.

Adolescent↗
PubMed2005

Paralytic strabismus as a manifestation of lyme borreliosis.

Lyme disease is a multi-system organ disorder caused by Borrelia burgdorferi. Although ocular manifestations have been reported, these remain a rare feature of the disease. This report shows a 49-years old patient that has been bitten by a tick and as consequence of which developed symptoms of the Lyme disease. In 1998 the patient was hospitalized in our Eye Clinic due to operating treatment of the paralytic strabismus (abductal nerve paralysis), as a rare feature of the Lyme disease. Postoperative squint angle was significantly reduced, but without any temporal movement. Diplopia was still present, though slightly reduced with the use of prism eyeglasses. The improvement of the quality of life was achieved, as well as the patient's satisfaction.

Borrelia burgdorferi↗
PubMed1991

[Palmoplantar epidermal atrophy with hypokeratosis, dys- and hypotrichosis, hypodontia, enamel and dentin hypoplasia, isolated cleft palate with cleft uvula, strabismus cryptorchism and other anomalies--an undescribed ecto-mesodermal dysplasia?].

A 15-year-old boy had suffered burning of both palms and all fingers during his 2nd year of life. Epitheliazation of the lesions did not occur. In his 6th year, erythema, desquamation and erosion-like alterations appeared spontaneously on the soles of both feet and on the plantar sides of the toes. These alterations were similar to those on the hands. Histologically the lesion on the right sole was covered with a very thin horny layer and thin epidermis. The cells of the epidermis had clear cytoplasm and probably derived from the ductal epithelium of the sweat glands. Under the atrophic epidermis, granulation tissue consisting of lymphocytes, plasma cells, histiocytes, and a few polynuclear cells and eosinophils was seen. The following symptoms were still present in the boy: dys- and hypotrichosis, oligodontia, enamel and dentin hypoplasia, cleft palate and uvula, concomitants strabismus (left eye), and cryptorchidism. Transplantation of the patient's skin from the right thigh to the lesion on the right sole was tried. The authors postulate a previously unreported form of ecto-mesodermal dysplasia in this case.

Abnormalities, Multiple↗