Transmuscular migration of 240 silicone encircling band.
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Adult↗
Biomedical subjects
G Klainguti
Publications and source records attributed to G Klainguti.
[Binocular diplopia after cataract operation].
BACKGROUND: The development of binocular diplopia after cataract surgery is a serious complication. The present retrospective study aims to improve our understanding of this phenomenon and its prevention. PATIENTS AND METHODS: A series of 11 patients with binocular diplopia after cataract surgery under local retrobulbar anaesthesia is presented. The patients were followed over a period ranging from 1 to 31 months. RESULTS: Three types of disorders were found: muscular or nervous injuries (7/11), decompensated latent heterophorias (2/11), and disclosed previous strabismus with abnormal retinal correspondence (2/11). The treatment was surgical for 3 patients, and a prismatic correction was prescribed for 6 patients. Spontaneous recovery was seen in 5 patients. CONCLUSION: Fortunately, binocular diplopia after cataract surgery is a rare complication, with multiple aetiopathologies. Muscular injuries, related to the anaesthesic technique, are the most frequent disorders responsible for diplopia and often require strabismus surgery.
Aged↗
[Surgical correction of subjective excyclotorsion by tucking the anterior part of the superior oblique muscle tendon].
BACKGROUND: Asymmetrical folding of the anterior portion of the superior oblique muscle is a simplified variant of the Harada-Ito procedure that is supposed to selectively correct ocular torsion. PATIENTS AND METHODS: This surgical technique was applied to 22 patients suffering from bilateral acquired IV nerve palsy. Ocular torsion was evaluated with the Harms tangent screen. Pre- and post-operative torsional values were compared. Post-operative follow-up was 12 months. RESULTS: Pre-operatively, mean excyclotropia was 8.8 degrees in primary position and 15.9 degrees in downgaze. Post-operatively, these values decreased to 1.5 degrees and 4.1 degrees, respectively. An enlarged field of binocular single vision, extending beyond 10 degrees inferiorly, was obtained in 17/22 patients. CONCLUSIONS: The selective technique of superior oblique muscle anterior tendon tucking allows one to efficiently correct the ocular torsion induced by acquired bilateral IV nerve palsy.
Diplopia↗
[Early surgery in infantile esotropia].
In Europe, early surgery for infantile esotropia is defined as surgery before 2 years of age for a strabismus of onset before 4 months. Subject to great controversy, the principal argument concerns binocularity, for some authors attainable with early surgery, for others an unreachable goal. In 2003, the European multicentric "Early versus Late Infantile Strabismus Surgery Study" compared the results of 2 groups of patients at 6 years of age, one having undergone early surgery, between the 6 (th) and the 24 (th) month of life (n = 231), the other later, between the 32 (nd) and the 60 (th) month of life (n = 301). Although slightly better in the early surgery group, the level of binocular functions in the vast majority of cases does not exceed that of subnormal or anomalous binocularity, while to achieve an equivalent postoperative angle the number of operations required was greater with early surgery. Aside from the above-mentioned study, cases of normal binocular single vision have long been reported after early surgery on both sides of the Atlantic. In North America it is sometimes believed that the earlier the surgery, the better the binocularity, some authors advising very early surgery, before 6 months of age. However, such reasoning is open to controversy since extremely early intervention increases the risk of including cases where the diagnosis is not fully established, in particular certain intermittent forms of strabismus that would explain some of the excellent binocular results. The virtue of being preventive rather than curative does not, however, offset the non-negligible fact that very early surgery does increase the risk of a greater number of operations. Indeed, very early surgery raises more questions than it answers, and the best age at surgery remains a subject open to debate.
Age Factors↗
[Surgical management of monocular torsion and head tilt after macular translocation].
BACKGROUND: Macular translocation following 360 degrees retinotomy is a possible surgical treatment of patients with age-related macular degeneration. However, it produces important subjective disturbances with diplopia and head tilt due to cyclodeviation. Complex surgical procedures involving both oblique muscles and two or four recti have been advocated. PATIENTS AND METHODS: Four symptomatic patients with macular translocation underwent counter-rotating surgery by very large recession and advancement of both oblique muscles of the affected eye. Preoperative subjective cyclo-deviations varied between 25 degrees and 60 degrees and head tilt ranged between 25 degrees and 45 degrees . RESULTS: Reduction of cyclodeviation ranged between 22 degrees ant 30 degrees in our four patients. Two patients showed residual cyclo-deviations of 3 degrees and 7 degrees with complete recovery of the head tilt. The remaining two patients showed significant subjective improvements and important reductions of head tilt, in spite of a large residual cyclodeviation. No patient exhibited binocular vision. CONCLUSION: Without jeopardizing the anterior segment blood supply of these elderly patients, a combined surgical procedure on both oblique muscles has shown to be sufficiently effective in reducing subjective cyclodeviation and head tilt in four cases of macular translocation. A complete counter-rotation does not seem to be required to achieve an important improvement of subjective symptoms. This may be due to sensorial adaptation.
Aged↗
[Treatment of a complication after surgical removal of an aneurysmal cyst of the ethmoid].
INTRODUCTION: An aneurysmal cyst (AC) is a rare benign bony tumor with a possible aggressive extension. We present a complication following the surgical ablation of an ethmoidal AC. CLINICAL HISTORY AND FINDINGS: A 40-year-old man with a left ethmoidal AC extending to the orbital roof underwent 2 surgeries. After the second one involving a neuro-surgical approach, a bilateral palsy of the superior oblique muscles (SO) appeared. The diplopia did not improve following a bilateral asymmetrical recession of the inferior recti muscles done elsewhere. There was an excyclotorsion up to 20 degrees in down gaze and a vertical deviation of 10 degrees in primary position. THERAPY AND OUTCOME: We performed a bilateral tucking of the anterior SO fibres with, on the left, an advancement of the inferior rectus and a resection of the medial rectus muscles. Two weeks after surgery the absence of cyclotorsional deviation allowed a binocular vision. CONCLUSION: The double vision due to the excyclotorsion, which was the main complaint, could be alleviated by an anterior strengthening of the SO. A precise measurement of the cyclotorsion is required for the surgical procedure.
Adult↗
Selective and sequential therapy of oculomotor and palpebral sequelae resulting from biopsy of dorsal midbrain sarcoidosis.
BACKGROUND: Biopsy of a dorsal mesencephalon lesion often leads to neuro-ophthalmological complications, namely dorsal mesencephalic syndrome, skew deviation, IV (th) palsy, or Horner's syndrome. HISTORY AND SIGNS: A 26-year-old man underwent a biopsy of the quadrigeminal plate for a lesion which revealed to be neurosarcoidosis. Post-operative complications included a left homonymous hemianopia, a left III (rd) nucleus palsy, a bilateral IV (th) palsy and a bilateral internuclear ophthalmoplegia. Palpebral fissures were narrowed to 2 mm on both sides. In primary gaze there was 24 degrees of exotropia, 17 degrees of right hypertropia and 30 degrees of exyclorotation. THERAPY AND OUTCOME: After 24 months of stable evolution, three oculomotor surgical procedures were performed including: surgery on both horizontal muscles of the left eye; shortening of both superior oblique muscles; resection of the right lateral rectus muscle, and posterior fixation of an inferior rectus muscle. Bilateral brow suspension on the frontal muscle of both superior eyelids was then performed. Evolution was favorable with a binocular single field of vision measuring 17 degrees horizontally and 20 degrees vertically centered on the primary gaze. Palpebral fissures measured 7 to 8 mm in primary gaze. CONCLUSIONS: The neuro-ophthalmological sequelae which followed the biopsy of a neurosarcoidosis lesion of the quadrigeminal plate were so severe that this patient was completely handicapped. A four-step surgery correcting the horizontal, torsional, vertical components, then the bilateral ptosis allowed the patient to recover both a satisfying function and esthetical aspect.
Adult↗
[Does amblyopia therapy make sense in eyes with severe organic defects?].
BACKGROUND: In eyes with severe organic defects the question arises if amblyopia therapy makes sense. PATIENTS AND METHODS: Three children are presented in whom despite severe organic eye diseases amblyopia therapy was tried. The first child had a unilateral large macular scar secondary to retinoblastoma treatment, the second a unilateral severe optic nerve atrophy secondary to an orbital hemangioma, and the third a unilateral large optic nerve coloboma. RESULTS: In the first case a reading visual acuity of 0.9 was achieved by occlusion therapy and in the second a reading visual acuity of 0.5. In the third case occlusion lead to alternation of the divergent strabismus (child too strongly retarded for reliable visual acuity measurements). CONCLUSIONS: During the sensitive phase, amblyopia therapy is also indicated in eyes with severe organic defects since good visual acuities can be achieved.
Amblyopia↗
[Decompensated strabismus surso-adductorius].
Strabismus surso-adductorius is a frequent unilateral or bilateral eye movement disorder. Its clinical features include eye elevation with concomitant vertical deviation in adduction, an abnormal head posture from which the patient is unaware (head turned and tilted towards the healthy side), a moderate subjective excyclotorsion, and a positive Bielschowsky head tilt test. Despite its anglo-saxon denomination as "congenital fourth nerve palsy", it is not a paretic disorder. Strabismus surso-adductorius differs from fourth nerve palsy both by etiology and by symptoms. A proper diagnosis is important as neuroradiological examination is mandatory in cases of acquired non-traumatic fourth nerve palsy, whereas decompensated strabismus surso-adductorius can be operated on without any further investigations. Early on, the oculomotor disorder is often well compensated and it does manifest at the adult age. Asthenopia and intermittent vertical diplopia appear as the fusional mechanisms fade out. The best surgical technique for strabismus surso-adductorius is an inferior oblique weakening procedure. In severe cases a combined shortening of the superior oblique tendon may be necessary.
Adult↗
[Use of contact lenses for correction of amblyopia in high unilateral myopia in children].
Persistent amblyopia in high unilateral myopia (anisometropia higher than or equal to - 3.5 diopters) has different causes: missed early diagnosis or therapeutic strategy error. With the intention of preventing the latter, we investigated the use of contact lenses. With occlusion treatment, we obtained substantial improvement of visual acuity of the amblyopic eye. Exophoric and exotropic patients retained all binocular vision and binocular union, as did most (3/4) of the microesotropic patients. This treatment has the advantages of being permanent, esthetic, and well accepted by parents.
Amblyopia↗
Myopexy (Faden) results in more postoperative vomiting after strabismus surgery in children.
BACKGROUND: Strabismus correction in children is associated with a high incidence of postoperative nausea and vomiting. The purpose of this prospective, double-blind study was to examine the influence of the surgical method for correction of squint on the incidence of postoperative vomiting. METHODS: One hundred and twenty consecutive children aged 2-12 years, scheduled for elective strabismus surgery, were enrolled in this prospective, double-blind study. A standardised total intravenous anaesthesia was given to all children. The development of perioperative oculocardiac reflex was noted and the number of episodes of vomiting during the first 48 h postoperatively was recorded. At the completion of the study, the children who were operated with myopexy according to Faden, were allocated to a Faden group, those without a myopexy to the non-Faden group. All the patients included in this study were operated on by the same surgeon with standardised techniques. RESULTS: The Faden group was younger, lighter and the operation time was longer (P<0.05). The incidence of vomiting was greater in the Faden group; 53% versus 12% (P<0.05). The incidence of oculocardiac reflex was similar in both groups; 40% in the Faden versus 28% in the non-Faden group, respectively. The total dose of propofol and alfentanil was similar between the groups. Requirement of analgesics for postoperative pain was similar in both groups. The only independent risk factor for postoperative vomiting was the Faden operation. CONCLUSION: The surgical method used for strabismus correction in children has a great influence on the incidence of postoperative vomiting. The Faden operation is associated with a very high incidence of postoperative vomiting; this particular group of patients has to be considered as a high risk group for postoperative vomiting and deserves an antiemetic prophylaxis.
Alfentanil↗
[Is there a primary and secondary torsion deviation in paralysis of the grand oblique muscle?].
BACKGROUND: An extraocular muscle palsy is conventionally characterized by a deviation of the visual axes, this being greater when measured with the affected eye fixing. By definition and illustrating Hering's law, this secondary angle of deviation is greater than the primary one, measured with the sound eye fixing. We present here a comparative study of the amount of subjective excyclodeviation measured in patients suffering from IVth nerve palsy, with the sound or affected eye fixing. METHODS: Two groups of patients were entered into the study: Group 1 (N = 54) for superior oblique palsies studied retrospectively and Group 2 (N = 14), for a prospective study of those recently acquired (post-traumatic) and followed over 6 months. In both groups, measurements were made at two stages, early (1 to 7 weeks after onset) and late (4 to 6 months later). RESULTS: In both groups, the majority of cases showed a greater secondary torsional deviation, the difference between this and the primary deviation lessening on late stage measurements. CONCLUSION: In both groups, the difference between primary and secondary torsional deviation was not statistically significant.
Exotropia↗
[Surgical treatment of accommodative convergence access esotropia. Study of 50 operated cases].
BACKGROUND: Convergence excess esotropia (EC) can be an additional component in all forms of strabismus. The most favourable prognosis is found in those cases where EC is associated with microtropia or bifoveal fusion, due to a better binocular potential. METHODS: 50 non selected cases were entered into the study and divided into two groups (Group A: EC with microtropia; Group B: EC with bifoveal fusion). All the patients were followed at the Lausanne Strabismus Unit and all cases underwent a bilateral medial rectus posterior fixation (Cüppers' Faden operation) placed at 13 mm from the original insertion. RESULTS: In Group A, the average reduction of angle of strabismus was 25 delta for near fixation, 20 delta in Group B. In both groups, the average decrease in angle for distance fixation was 6 delta. In Group A, 75% of cases gained some binocularity post-operatively, not only for distance but also for near fixation. In Group B, all the patients showed a normal response on the Lang stereotest post-operatively. CONCLUSIONS: In both groups of this study, a bilateral medial rectus retroequatorial myopexy was a satisfactory alternative for those patients who refused to wear bifocal glasses.
Accommodation, Ocular↗
[Surgery of strabismus and rupture of the blood-aqueous barrier (ischemia of the anterior segment)].
BACKGROUND: First described in 1957, anterior segment ischemia (ASI) following extraocular muscle surgery for non paralytic or paralytic strabismus is a rare but serious complication. Systemic and anatomical risk factors can be identified and vesselsparing surgical techniques used. The aim of this study is to evaluate those changes in the anterior chamber that may indicate the presence of post-operative subclinical ASI. METHODS: Pre- and 1 day post-operative anterior chamber flare measurements with the Laser flare cell meter (Kowa FC-1000) were made in 107 patients (109 operations) undergoing strabismus surgery. Surgery was carried out by the same surgeon in all cases and under general anaesthesia. Patients were divided into different groups according to the muscles operated (horizontal recti, vertical recti, obliques, or combinations thereof). RESULTS: Global and selective analysis showed no significant statistical difference between pre- and post-operative flare measurements in patients undergoing strabismus surgery. CONCLUSION: No subclinical ASI was found in this study of 109 strabismus operations (107 patients).
Adolescent↗
[Cüpper myopexy as treatment of pseudoptosis; apropos of 2 cases].
BACKGROUND: According to Hering's law, the induced palsy of an extraocular muscle will result in an increased innervational flow to this muscle as well as to its contralateral synergist. A retroequatorial myopexy (Cüppers Faden Operation), with or without muscle recession, can be considered as an iatrogenic palsy. METHODS: Two patients, aged 16 and 5 years respectively, presented with hypotropia, the deviated eye showing limited ocular movements in elevation and pseudoptosis of the upper eye lid. Both patients underwent surgery, this consisting of a posterior fixation and recession of the superior rectus of the sound eye. RESULTS: After surgery, both cases showed a stable improvement of the opening of the palpebral fissure and of the vertical deviation. CONCLUSIONS: This surgical procedure was already described by Cüppers and, although rarely performed, does represent a useful surgical alternative in cases of partial ptosis of the upper eye lid together with hypotropia.
Adolescent↗
[Inclination of the Hess-Weiss coordimetric graph. An indirect sign of ocular torsion?].
BACKGROUND: The coordimetric examinations according to Hess-Weiss (HW) and Hess-Lancaster produce the bidimensional graphic demonstration of eye deviations. The horizontal and vertical deviations can be shown easily, whereas cyclotorsion cannot be detected readily. Clinical experience has suggested, however, that there may be an association between rotation of the HW graph and cyclotorsion. The question is, how much can the bidimensional presentation be influenced by the cyclotorsion? METHODS: 48 patients with posttraumatic superior oblique palsy were investigated. The cyclotropia measured at the tangent scale of Harms (dark-red glass method) was compared to the rotation of the HW graph. Patients were divided into 2 groups: 27 unilateral and 21 bilateral palsy. CONCLUSION: The association between the two examination parameters was significant in both patient groups (Group 1 p < 0.01, Group 2 p < 0.05).
Adolescent↗
[Strabismus and Williams-Beuren syndrome. Presentation of 3 operated cases].
BACKGROUND: Williams-Beuren syndrome (WBS) is a developmental disorder of unknown etiology. The classical features include: 1) a supravalvular aortic stenosis, 2) "elfin" facies and 3) mental deficiency. Ocular findings can be irisabnormalities (stellate, pattern), tortuositas vasorum and, though not essential for diagnosis, strabismus is commonly found. Three cases of WBS with convergent squint which underwent surgical treatment are presented. Biopsy and histological studies were performed in two cases. MATERIAL AND METHODS: Strabismus onset was diagnosed before the second year of life in all three. Pre-operative esotropia (ET) was 45, 40 and 62 delta. Age at operation was respectively 52,67 and 87 months. Surgical treatment consisted in recess-resect procedures on horizontal muscles. Biopsy was performed in two cases. RESULTS: Three months after surgery, angular measurements were respectively: exotropia (XT) 6 delta, ET 2 delta, ET 10 delta. Anatomopathological findings showed normal tendon tissue. DISCUSSION: No particular motility disturbances or pattern have been found in our patients. Amount of surgery has been chosen according to routine. Amblyopia treatment could be performed as usual. Treatment in our patients with WBS has been similar to ordinary cases of strabismus. Medium-term results do not differ from other squinting patients treated with similar procedures.
Child↗
[Oblique retro-equatorial myopexy].
BACKGROUND: The mechanical principle of Cüppers' Fadenoperation consists in reducing the lever arm and in lengthening the arc of contact. We describe herein a surgical procedure that abides by this principle but creates an oblique line of adherence of the muscle to the sclera. PATIENTS AND METHODS: Five patients were operated on (3 for oblique superior palsy, 1 for orbital floor fracture, 1 for partial IIIrd cranial nerve palsy). Oblique retroequatorial fixation was applied on 4 inferior recti and on 1 superior rectus. Fixation was achieved with 5.0 prolene, the temporal suture being placed 14 mm behind the original insertion and the nasal one 12 mm behind the original insertion. RESULTS: In 4 patients, Fadenoperation of the inferior rectus muscle placed in an oblique way satisfactorily reduced the vertical deviation. The amount of reduction was comparable to what could be expected of a classic posterior fixation at 13 mm behind insertion. In addition, a slight reduction of excyclotropia in downgaze was noted. CONCLUSION: No anatomical fact seems to speak against an oblique setting of sutures when performing Fadenoperation of the inferior rectus, and this procedure can be applied to cases with incomitant vertical deviation and slight excyclotropia in downgaze.
Adolescent↗