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G Klainguti

Publications and source records attributed to G Klainguti.

35 records · Page 2Linked to original sources
PubMed1996

[Partly accommodative convergent strabismus with and without excess convergence. Surgical treatment].

BACKGROUND: Partly accommodative esotropia typically shows a persistent convergent angle after correction of hypermetropia. This condition can-or cannot-be accompanied by an accommodative convergence excess. PATIENTS AND METHODS: Fifty patients were examined, operated on and followed up by the same team, and were separated into 2 groups: Group 1: partly accommodative esotropia without convergence excess (N = 20); Group 2: partly accommodative esotropia with convergence excess (N = 30). The operations of the first group consisted of 11 posterior fixations (Fadenoperations) on both internal recti (IR), and 9 combined horizontal operations or recessions of both IR. The operations of group 2 consisted of 23 Fadenoperations and 7 classic procedures. RESULTS: Comparison of angle reductions after a 6-month follow-up showed that posterior fixation was more effective in reducing esotropia when measured without glasses (p = 0.003), whereas both techniques produced similar effects when angles were considered with correction of hypermetropia. In group 2, the effects of posterior fixation on residual angles at near were significantly higher than on angles measured at distance fixation (p < 0.001). Objective refraction (median) was S + 3.60 for group 1 and S + 1.75 for group 2. CONCLUSION: Fadenoperation appeared to satisfactorily reduce convergence excess in our group of 30 patients with partly accommodative esotropia. In our series of 20 patients with accommodative strabismus without convergence excess, Fadenoperation was more effective only when angles were considered without glasses.

Accommodation, Ocular↗
PubMed1995

[Treatment of alphabetic "V" syndromes].

BACKGROUND: Described in the early fifties, V phenomenon remains a controversial subject in respect to its etiopathogeny. Several theories have been proposed dealing to specific surgical treatments. According to the "oblique" theory, we have been performing a bilateral inferior oblique muscle weakening procedure alone or combined with horizontal muscle surgery in our patients presenting horizontal squint associated with a "V" phenomenon. MATERIALS AND METHODS: Since 1984, among the 103 patients presenting with a "V" phenomenon, we have been able to analyze 55 cases (40 "V" esotropias and 15 "V" exotropias) who underwent 3 different surgical protocols; 1) bilateral inferior oblique (IO) muscles weakening procedure combined with conventional horizontal surgery, 2) bilateral IO weakening procedure combined with posterior fixation of Med. Recti (Faden operation) in esotropias only, or 3) bilateral inferior oblique muscles weakening alone. All groups were comparable in respect with there pre-surgical "V" pattern. RESULTS: No statistical significant difference in reduction of the "V" pattern could be demonstrated in the different treatment protocols. "V" esotropias showed a mean 16.3 delta diopter reduction +/- 2.2 SEM in treatment number 1; 19.8 +/- 2.1 in treatment 2. Reduction was only 10.7 +/- 3.3 in group with third treatment. "V" exotropias reduction were: 15.4 delta diopter +/- 1.6 in the combined surgical procedure compared to 18.3 +/- 4.8 in IO weakening alone. No dose-effect relationship could be clearly demonstrated in measured IO weakening procedure. CONCLUSIONS: IO weakening procedure is effective in reducing "V" pattern. This effect is enhanced if associated with an horizontal muscle surgery which reduces the horizontal deviation especially in in V esotropias. We prefer Fink's procedure to simple myotomy since its allows a measurable and reversible IO weakening.

Convergence, Ocular↗
PubMed1995

[Stilling-Duane retraction syndrome; surgical options].

BACKGROUND: The Stilling-Duane's retraction syndrome is a congenital abnormality of ocular movements. In order to maintain simple binocular vision, most patients adopt an abnormal head posture; this can be corrected by surgery. MATERIALS AND METHODS: We carried out a retrospective study of the clinical files of 56 patients who presented with Duane's syndrome and had been examined at the Strabological Department of the Lausanne Eye Clinic between 1974 and 1993. RESULTS: Our group study is comparable to that found in the literature as regards the distribution according to sex (45% of males, 55% of females), laterality (75% of the cases with disease predominance in the left eye, 18% in the right eye, and 7% with bilateral, symmetrical disease), and associated anisometropia (18%) or amblyopia (12.5%). Approximately 1 of 5 patients sought medical advice only after 20 years of age. A compensating head turn (towards the ill side in patients with esotropia and towards the healthy side in patients with exotropia) was found in 71% of the cases. Our surgery (10 patients with a mean follow-up of 8 months) resulted in a decreased head turn in 7 cases. CONCLUSIONS: The purpose of this surgery is to improve the head turn without worsening retraction. This can be achieved with simple muscle recessions.

Adolescent↗
PubMed1995

[Diagnosis and surgical treatment of bilateral paralysis of the superior oblique muscle].

BACKGROUND: Typically, bilateral superior oblique palsies manifest with small vertical deviation in primary position, reversing in lateral gaze, with a positive headtilt test on both sides, a V pattern, and a chin-down head position. In primary position, excyclotropia often exceeds 10 degrees and markedly increases in inferior gaze. PATIENTS AND METHODS: Retrospective study of 21 patients with bilateral SO palsy who underwent operations including various surgical techniques such as SO tucking, inferior oblique recessions and inferior rectus weakering procedures (recession, posterior fixation). Preoperative symptoms of this group of patients was compared to those of 60 patients with unilateral SO palsy. RESULTS: No significant difference was found between cases operated with complete SO tucking and cases operated with specific surgery on the anterior part of the tendon when pre- and postoperative excyclotropia was compared. Severe excyclotropia in primary gaze, markedly increasing in downgaze, was found to be statistically significantly associated with bilateral lesions (p = 0.001). CONCLUSION: Bilateral SO palsy, even when highly asymetrical, can be surely diagnosed by carefully measuring excyclotorsion in both primary and downgaze by using dissociating devices. To avoid iatrogenic postoperative Brown syndrome it is recommended to adjust the amount of bilateral superior oblique tucking peroperatively, according to the degree of tendon extensibility. In cases of very severe excyclotorsion such a procedure can be completed by mild bilateral simultaneous inferior oblique recessions.

Adolescent↗
PubMed1995

[A new software for handling surgical data in strabology].

BACKGROUND: Numerous measurements and data are the hallmark of strabismology. Handling these data is greatly facilitated by the use of computers. An adequate software should also allow surgical results analysis and quality control. Standardisation of data is mandatory. METHODOLOGY: We developed such an application based on a commercially available database (4th Dimension, ACI Paris). It uses 5 relational files. RESULTS: This software is userfriendly and can be used by anyone. No special code is necessary to enter data and these values are automatically verified. Patient's data, diagnosis, type of surgery and angle measurements (pre- and post surgery) can be entered, usually by an orthoptist, right after examination. CONCLUSION: Numerisation of strabologic surgical data can be easily realised with the help of a programmable database, but rigorous terminology is mandatory. Indeed the use of a strict terminology is helpful in teaching hospitals.

Computer Graphics↗
PubMed1994

[Surgical treatment of superior oblique paralysis].

BACKGROUND: Reduction of vertical deviation and ocular torsion are the goals of any surgical treatment of superior oblique palsy. PATIENTS AND METHODS: Our study (n = 70) compares different surgical approaches: Resection (Tuck) of the superior oblique, recession of the inferior oblique, combined operation on both obliques of the involved side, posterior fixation of the inferior rectus on the fellow eye, with or without simultaneous tuck of the paretic superior oblique, Harada-Ito procedure. Reduction of the vertical deviation in different directions of gaze and reduction of cyclotropia in primary position have been compared for each type of operation.

Adolescent↗
PubMed1994

[An objective measure of ocular torsion: a new indirect ophthalmoscopy lens].

PURPOSE: Ocular torsion can be measured by different means. While subjective methods are commonly used in ophthalmological practice, objective methods are time consuming and require expensive photographic equipment. The authors present a new ophthalmoscopic lens which allows a rapid and quantitative evaluation of cyclotropia. PATIENTS AND METHODS: Objective measurement of the optic nerve head (ONH)-foveal angle was performed in 30 eyes of 15 normal volunteers. Results were compared, for each subject to those obtained when measuring ocular torsion by two subjective methods: double Maddox rod and dark red glass in front of Harms' tangent screen. RESULTS: The new ophthalmoscopic lens showed a mean slight incyclotortion of 0.40 degrees +/- 0.20 (SEM) while Harms' tangent screen a mean slight excyclotortion of 0.12 degrees +/- 0.20 and double Maddox rod absence of torsion: 0.02 degrees +/- 0.20. No statistical difference was shown when comparing the three methods with Student paired T test. CONCLUSIONS: The new ophthalmoscopic lens allows a rapid and quantitative evaluation of ocular torsion. Measurements can easily be performed during routine fundus examination by any practitioner.

Adult↗
PubMed1994

[Early surgery of convergent strabismus. Preliminary results of a series of 45 cases].

BACKGROUND: The age for strabismus surgery remains controversial and the various studies differ whether the results of residual angle and binocular vision may be better with early or late surgery. Different operating techniques for infantile esotropia have been proposed: recession of both medial recti, combined surgery on horizontal muscles, posterior fixation on one or both eyes, posterior fixation with simultaneous recession, botulin injection. PATIENTS: Our study presents 45 children with congenital esotropia operated at a mean age of 18.5 months. The surgical technique consisted of posterior fixation of both medial recti with or without simultaneous recession.

Age Factors↗
PubMed1994

[Superior oblique muscle paralysis and ocular torsion. What is the effect of measuring method on the results?].

BACKGROUND: The rotation of the eye-ball around Fick's Y-axis is called ocular torsion. A precise measurement of the torsional deviation can be clinically as critical in the diagnosis of some complex strabological disorders as in the assessment of some systemic diseases. MATERIALS AND METHODS: We measured the ocular torsion under binocular conditions by five measurement devices on 50 patients with superior oblique palsy. The comparison of the devices was performed using rank tests (Friedman, Wilcoxon signed rank). RESULTS: The 5 methods of measurement do not produce equivalent results. These findings confirm on a population of paretic patients similar published results obtained with healthy subjects. CONCLUSIONS: The simple Maddox rod and the synoptophore are among the most widely used methods to measure cyclotropia; this study reveals that these devices are the least reliable. Harm's tangent scale gives the most reliable results, in all directions of gaze; however, in inferior adduction, the synoptometer also yields a satisfactory measure of ocular torsion. In primary position, the double Maddox glass appears to be the most suitable instrument.

Adolescent↗
PubMed1993

Fundus changes associated with congenital hypertrophy of the retinal pigment epithelium.

The clinical characteristics and follow-up changes of 64 patients with solitary congenital hypertrophy of the retinal pigment epithelium were studied. Thirty-five of the patients were followed up for one to 14 years with serial fundus photography. Progressive increase of the hypopigmented part of the lesion was observed in 29 of the 35 patients who were followed up (82.8%). An enlargement of the lesion was seen in 26 of the 35 patients (74.3%). Two additional changes, that is, pigmented areas adjacent to congenital hypertrophy of the retinal pigment epithelium and linear streaks of the pigment epithelium, were documented. Pathogenetic mechanisms for the development of these changes remain unknown.

Adult↗
PubMed1993

Orbital infarction syndrome.

BACKGROUND: The authors define orbital infarction as ischemia of all intraorbital and intraocular structures. It is a rare disorder due to the rich anastomotic vascularization of the orbit. PATIENTS: The authors report three patients with orbital infarction with similar clinical presentations: acute blindness, orbital pain, total ophthalmoplegia, and anterior and posterior segment ischemia. RESULTS: Etiologies of orbital infraction syndrome include occlusion of the common carotid artery (case 1), giant-cell arteritis (case 2), and mucormycosis (case 3). CONCLUSION: Three cases discussed in this article illustrate that orbital infarction is a disorder that can occur secondary to different mechanisms such as (1) acute perfusion failure (e.g., common carotid artery occlusion [possibly combined with anomalous orbital anastomotic channels]), 2) systemic vasculitis (e.g., giant-cell arteritis), and (3) orbital cellulitis with vasculitis (mucormycosis). The blindness and retinal and optic nerve damage were permanent, whereas the other signs of orbital ischemia (ophthalmoplegia and anterior segment ischemia) resolved. Therefore, diagnosis of orbital infarction can best be made during the acute phase.

Aged↗
PubMed1992

[Comparison of five methods for subjective assessment of ocular cyclodeviation].

METHODS: 1. simple Maddox rod (Franceschetti) 2. set of scaled large diameter Maddox rods 3. synoptophore 4. synoptometer (Cüppers) 5. dark red glass in front of the Harms tangent scale (Kolling). Whereas the first two methods allow to measure in primary position only, the other three also permit secondary and tertiary position measurements. Thirty normal subjects underwent comparative measurements by means of the above techniques in monocular and binocular condition. The median values indicate that all these methods are reliable but that certain specific differences influence the results. For this reason, pre- and postoperative measurements of ocular torsion should always be performed by the same method. The most appropriate techniques have shown to be: the set of scaled Maddox rods for measurements in primary position only, the dark red glass in front of the Harms tangent screen for measuring also in secondary and tertiary positions.

Convergence, Ocular↗
PubMed1992

["Blow-out" orbital trauma and diplopia. Conservative or surgical approach?].

The treatment of orbital fractures, type blow-out, has always been discussed about. One hundred-twenty patients, subdivided in four groups were examined. Incarceration of the peri-muscular structures or not. Surgical or conservative treatment. These four groups have been studied with the purpose of establishing a treatment plan, which implicated the different time of healing up to a complete and functional recovery. Our purpose is to explain why we suggest a conservative attitude and the necessity of proceeding with radiological screening along with an examination of the binocular eyesight.

Adolescent↗
PubMed1991

[Short- and intermediate-term angular results of Cüppers retro-equatorial myopexy, with or without additional simultaneous recession].

79 variable esotropias underwent bilateral "Fadenoperations". In the first group, the posterior fixation has been performed alone. In the second series, conventional symmetrical recessions of the medial recti have been performed during the same procedure. Two further additional weakening techniques are compared in the last group: anterior medial tenotomies and the so-called "stretch effect". Concomittant recessions considerably enforced the amount of angle reduction for distance and near without affecting precision, predictibility and stability of the results. Tenotomies and stretching procedures were followed by inconstant results.

Accommodation, Ocular↗
PubMedDate not supplied

Vertical and torsional correction in congenital superior oblique palsy by inferior oblique recession.

PURPOSE: Inferior oblique recession (Fink's technique) is one of various surgical procedures to manage congenital superior oblique muscle palsy. The authors aimed to determine the effectiveness of this operation in reducing vertical deviation and torsional deviation, and to assess the dose-effect relationship. METHODS: Fifty-eight patients presenting with unilateral congenital superior oblique palsy had an inferior oblique recession of 6 mm, 8 mm, or 10 mm (16, 35, and 7 patients, respectively). Vertical deviation and torsional deviation were measured before and after surgery by means of the dark red glass dissociation in front of Harms'tangent screen and the data were analyzed retrospectively. RESULTS: A cure rate of 88% was achieved, with no complications, and no overcorrections. For the 34 patients for whom long-term follow-up was possible (mean 2.8 years), final median postoperative vertical deviations and torsional deviations were 0.5 degrees and 0 degrees, respectively, both in primary position and in adduction upgaze. CONCLUSIONS: Inferior oblique weakening by recession proves to be an efficient and safe procedure for congenital superior oblique palsy, and its effect on vertical deviation can be predicted on the extent of recession. The operation can therefore be adapted to the patient, depending on the degree of the preoperative deviation.

Adolescent↗