Torsional diplopia after transantral orbital decompression and extraocular muscle surgery associated with Graves' orbitopathy.
Explore the source record for details and available documents.
Diplopia↗
Biomedical subjects
B J Kushner
Publications and source records attributed to B J Kushner.
A surgical procedure to minimize lower-eyelid retraction with inferior rectus recession.
Advancement of the capsulopalpebral head at the time of inferior rectus recession has been described as a technique to minimize postoperative lower-eyelid retraction. In a prospective randomized masked clinical trial, this technique combined with inferior rectus recession was compared with inferior rectus recession alone, with respect to post-operative lower-eyelid retraction. The mean (+/- SD) postoperative lower-eyelid retraction was 0.7 +/- .82 mm for patients in whom the capsulopalpebral head was advanced, as opposed to 1.3 +/- .85 mm for the control group. This difference was statistically significant (Student's t = 2.787; P = .006).
Eyelids↗
Subconjunctival cysts as a complication of strabismus surgery.
Six patients were operated on for large subconjunctival cysts that developed up to 35 years after strabismus surgery. In four of these patients the cyst was found to arise between the anterior edge of the muscle and the site to which the muscle had been sutured during previous surgery. The muscle was attached to the posterior wall of the cyst and not to the sclera. A pseudotendon was found running between the point on the sclera to which the muscle had been sutured and the undersurface of the muscle far posteriorly. In the other two patients a sudoriferous cyst was found that the referring ophthalmologist had mistakenly thought to represent an abscess when excision was attempted.
Child, Preschool↗
Unexpected cyclotropia simulating disruption of fusion.
Fifteen patients with diplopia associated with prior scleral buckling, prior penetrating keratoplasty, severe corneal scarring, monocular aphakia, long-standing strabismus, or prior vertical offsets of the horizontal recti were thought to have disruption of fusion because diplopia could not be eliminated with prisms. They were each found to have a substantial symptomatic cyclotropia unassociated with an obvious dysfunction of an oblique muscle. In 13 patients, diplopia resolved after the cyclotropia was corrected surgically.
Aphakia↗
'V' esotropia and excyclotropia after surgery for bilateral fourth nerve palsy.
Six patients had residual diplopia at near in the downgaze position after surgery for bilateral fourth nerve palsy. They all showed a large excyclotropia in the downgaze position that was associated with a "V"-pattern esotropia and could not fuse in the reading position because of the size of the excyclotropia. They were treated with bilateral recessions of the inferior recti, which resulted in an expansion of the single binocular field of vision in downgaze, with an elimination of diplopia in the reading position. None experienced a deterioration in their alignment in the primary position.
Adult↗
Postoperative binocularity in adults with longstanding strabismus.
The authors tested preoperatively and postoperatively for binocularity with the Bagolini lenses in a series of 359 adults who underwent surgery for long-standing constant strabismus. Eighty-six percent of patients showed a binocular response with the Bagolini lens test almost immediately after surgery. Regardless of the type of deviation present preoperatively, the duration of strabismus, or the depth of amblyopia in the deviating eye (if present), the vast majority of patients developed binocularity. The development of binocularity with the Bagolini lenses after surgery appears to be related to the stability of the postoperative ocular alignment.
Adult↗
Large rectus muscle recessions for the treatment of congenital nystagmus.
Explore the source record for details and available documents.
Humans↗
Pseudo inferior oblique overaction associated with Y and V patterns.
Nine patients with Y or V patterns are presented. All patients had an eye movement pattern that resembled but was distinctly different from bilateral inferior oblique overaction. Despite marked abduction of either eye when it elevated in adduction, no patient had elevation of the adducting eye on direct side gaze, superior oblique underaction, a forced head tilt difference, or torsion. Weakening of the inferior obliques in four of these patients, either with surgery or temporary chemodenervation, did not eliminate this pseudo inferior oblique overaction movement. Recession and elevation of the lateral recti normalized the ocular rotations in three patients. The author proposes that these patients represent a variant of the co-contraction syndrome.
Adolescent↗
Variation in axial length and anatomical landmarks in strabismic patients.
The authors calculated axial length measurements in 185 consecutive patients undergoing strabismus surgery and found a mean measurement of 21.98 +/- 1.59 mm (range, 18.75-25.37 mm). Although significant correlation between axial length, refractive error, and age was found, wide variation was present, which indicates that age and refractive error could not accurately predict axial length. Based on a formula derived from a geometric model to determine the equator-limbus distance, given the axial length, the authors found that the equator had a mean distance from the limbus of 11.56 +/- 1.75 mm (range, 9.10-13.76 mm). Based on the variability found at surgery for the insertion-limbus distance, the number of millimeters of recession of the medial rectus from the insertion that would have been necessary to place it at the equator ranged between 3.5 and 8.5 mm in this series, and for the lateral rectus, 3.5 mm to 7.0 mm. The number of millimeters necessary to recess the lateral rectus to its point of tangency with the globe ranged between 9.5 and 14.4 mm.
Adolescent↗
Excessive loss of hyperopia. A presenting sign of juvenile aphakic glaucoma.
We present the cases of four patients in whom juvenile aphakic glaucoma developed. An excessive loss of hyperopia was the initial clinical sign that alerted us to the diagnosis of glaucoma. At the time of diagnosis, the mean refractive error of the six glaucomatous eyes in the four patients was +4.75 diopters (D) (range, -0.25 to +6.75 D). The mean change in refraction from time of cataract extraction to diagnosis of juvenile aphakic glaucoma was 17.00 D (range, 9.25 to 21.00 D). All aphakic patients in the private practice of one of us (B.J.K.) with a spherical equivalent of less than +8.00 D in either eye have glaucoma. The only exception are those patients with a coexisting condition predisposing them to myopia. We have found an excessive loss of hyperopia to be a useful sign in alerting the ophthalmologist to the diagnosis of juvenile aphakic glaucoma.
Aphakia, Postcataract↗
Vertical rectus muscle transposition and botulinum toxin (Oculinum) to medial rectus for abducens palsy.
Ten adult patients developed sixth-nerve palsy after trauma or a cerebral tumor. No clinical evidence of recovery of function was noted by at least 8 months after onset. All patients underwent total transposition of the superior and inferior rectus muscle insertions to the area of the lateral rectus insertion, accompanied by botulinum toxin (Oculinum) injection of the ipsilateral medial rectus. These patients developed a mean diplopia-free field of 51 degrees, with a diplopia-free field in the abducted field of 20 degrees. This procedure involved surgery on only two rectus muscles, but the results compared favorably with surgical strategies involving three rectus muscles. Thus, the risk of developing anterior segment ischemia was greatly reduced.
Abducens Nerve↗
The influence of axial length on the response to strabismus surgery.
We performed axial length determinations preoperatively on a series of patients undergoing strabismus surgery. A statistically significant inverse correlation was found between axial length and the response (prism diopters per millimeter of medial rectus recession) for esotropic patients. The data suggest that a surgical formula designed to take axial length into account would decrease the variability in response to strabismus surgery in esotropic patients. Poor correlation was found between axial length and response to surgery in exotropic patients. We feel this poor correlation was due, in part, to the postoperative drift rate in exotropic patients as well as inaccuracies with the standard techniques used to determine the basic deviation on which surgery in exotropic patients is based.
Adolescent↗
Should recessions of the medial recti be graded from the limbus or the insertion?
In a series of 27 patients who were operated on for esotropia, we compared patient response to surgery and the distance the medial recti were recessed from the insertion and corneoscleral limbus. We found a much more significant correlation between the response and the amount the muscles were recessed from the insertion than from the corneoscleral limbus. Using partial correlation coefficients, we found that when we corrected for the amount of recession from the insertion, there was not a significant correlation between the response to surgery and the amount the muscles were recessed from the corneoscleral limbus. This suggests that the apparent correlation between the response to surgery and the amount of recession from the corneoscleral limbus simply reflects that the greater the recession from the corneoscleral limbus, the farther the muscle is likely to end up posterior to the insertion.
Accommodation, Ocular↗
Errors in the three-step test in the diagnosis of vertical strabismus.
The Parks three-step test is the standard for diagnosing which isolated cyclovertical muscle is palsied. It does not, however, tell the examiner if in fact one is dealing with a palsy of one cyclovertical muscle. Numerous other causes of vertical strabismus may have a positive Bielschowsky head tilt test. The use of the three-step test in these clinical situations may lead to incorrect diagnosis and treatment. These clinical conditions include contracture of the vertical recti, paresis of more than one vertical muscle, dissociated vertical divergence, previous vertical muscle surgery, skew deviation, myasthenia gravis, and small nonparalytic vertical deviations associated with horizontal strabismus. Several diagnostic steps in addition to the three-step test are necessary to tell if one is in fact dealing with a palsy of a single cyclovertical muscle.
Adult↗
The diagnosis and treatment of bilateral masked superior oblique palsy.
I reviewed retrospectively the records of 147 consecutive patients who had superior oblique palsy. Of the 147 patients, 28 had bilateral superior oblique palsies, and in nine of the 28 the involvement was so asymmetric that the palsy in the lesser affected eye was either completely masked or almost masked preoperatively. Relying on preoperative diagnostic criteria such as the presence of bilateral objective torsion, cover testing in the oblique fields of gaze, size of the subjective cyclotropia, amount of the "V" shift, and subjective symptoms, all nine patients underwent bilateral surgery at the time of their initial operation and obtained satisfactory results. No patient was later found to have bilateral masked superior oblique palsy after unilateral surgery.
Adolescent↗
Case report. Ocular muscle fibrosis following cataract extraction.
Explore the source record for details and available documents.
Aged↗
Paradoxic pupillary phenomena. A review of patients with pupillary constriction to darkness.
The presence of pupillary constriction to darkness is said to be a useful indicator of retinal disease. However, it is also associated with optic nerve disease. The phenomenon has been reported in patients with congenital stationary nightblindness, congenital achromatopsia, bilateral optic neuritis, and dominant optic atrophy. We have observed this response in additional disorders, including anomalies of the optic nerve development, congenital nystagmus, and a variety of diseases affecting the retina. Notably, four of our patients with strabismus and amblyopia, but without apparent retinal or optic nerve disease, have also demonstrated this paradoxic pupil response. While the mechanism for pupillary constriction to darkness remains unclear, the finding of this response in patients without retinal or optic nerve abnormalities questions its value as a localizing sign.
Child, Preschool↗
Successful treatment of functional amblyopia associated with juvenile glaucoma.
Twelve patients with either unilateral or bilateral juvenile glaucoma underwent standard amblyopia management for the treatment of suspected functional amblyopia secondary to their glaucoma. Despite the presence of glaucomatous cupping or corneal changes, the amblyopia therapy was successful in ten patients.
Amblyopia↗