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Synthetic absorbable suture for strabismus surgery.

Polyglactin 910 (Vicryl), a synthetic absorbable braided suture in 5-0 or 6-0 size, was satisfactory for recession and resection of extraocular muscles. It produced an acute allergic reaction in only one of 89 cases (1.5%) as compared to a 19% reaction when collagen suture of like size was used. Polyglactin 910 suture, when left partially exposed, may be irritating and can cause excessive reaction when used at the conjunctival limbus.

Collagen↗

Abnormal saccades in paralytic strabismus.

Saccadic eye movements were measured in ten patients with unilateral limitation of function of an extraocular muscle. With the paretic eye fixating, there were a series of saccades when refixating in the direction opposite to the paralysis. Between each saccade, the eye drifted back toward the starting position; the drift rate decreased as the eye moved into the field of action of the strong agonist muscle. In one patient, the normal (covered) eye was immobilized during attempted refixations. In this case, the abnormal pattern of saccades made by the paretic eye persisted. Thus, the central nervous system uses innervation or efference to calculate the position of the eye in the orbit for saccadic eye movements.

Eye Movements↗

Sustained increases in intraocular pressure during strabismus surgery.

We measured intraoperative intraocular pressure in nine eyes of six patients, 34 to 55 years old, undergoing rectus muscle recession or resections and found sustained intraocular pressures of 77 to 84 mm Hg in the five eyes (three patients) affected by thyroid ophthalmopathy. Smaller increases were noted in the four eyes without muscle restrictions.

Adult↗

Fadenoperation for the management of complicated incomitant vertical strabismus.

We reviewed retrospectively the records of 17 patients with incomitant vertical diplopia secondary to an underacting inferior rectus muscle who had been treated by surgically weakening the contralateral inferior rectus muscle with a posterior fixation suture (fadenoperation). This was the sole procedure in four patients with blowout fractures and in two patients with restriction secondary to scleral buckling procedures. It was combined with horizontal or vertical muscle surgery in 11 patients. The procedure was particularly useful in preventing diplopia on downgaze after excessive weakening of a tight inferior rectus muscle in seven patients with thyroid ophthalmopathy. In three patients it was used in anticipation of an iatrogenic incomitancy in downgaze secondary to a large recession of a tight inferior rectus muscle. All patients were markedly improved after surgery and no complications were encountered.

Adult↗