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Biomedical subjects

H S Metz

Publications and source records attributed to H S Metz.

At least 37 records · Page 2Linked to original sources
PubMed1983

Saccadic velocity measurements in strabismus.

Traditional evaluation of strabismus has included cover test measurements, evaluation of the range of ocular rotations, and an array of subjective sensory tests. These studies could not always differentiate paresis of an extraocular muscle from restrictions and from various neuro-ophthalmic motility disorders. The measurement of horizontal and vertical saccadic movements can provide an objective test of rectus muscle function. Using EOG, saccades can be recorded easily, inexpensively, and repeatably at any age. In ocular muscle paresis or paralysis, saccadic speed is reduced mildly to markedly and can be used to monitor recovery. Assessment of saccadic velocity does not appear useful in evaluating superior oblique palsy, although it is valuable in sixth nerve palsy, Duane's syndrome, and third nerve palsy. When restrictions are the major cause of limited rotation, as in thyroid ophthalmopathy and orbital floor fracture, saccadic speed is unaffected. The induction of OKN or vestibular nystagmus is helpful in the study of children too young to perform voluntary saccadic movements. In patients with limitation of elevation or depression, this technique can separate innervational from mechanical causes of diminished rotation. The specific saccadic velocity pattern in myasthenia gravis, progressive external ophthalmoplegia, internuclear ophthalmoplegia, and Möbius' syndrome is helpful in differentiating these disorders from other neuroophthalmic motility problems. Transposition surgery of the rectus muscle is effective because of an increase in force, seen as an improvement in saccadic velocity and resulting from the change of insertion of the muscles. Saccadic velocities can also be of assistance in diagnosing a lost or disinserted muscle following surgery for strabismus. Although analysis of saccadic velocity is not required for the proper evaluation of all problems in strabismus and motility, it can be of inestimable value in the diagnosis of many complex and confusing disorders. Together with forced duction testing, a clinical profile can be obtained concerning muscle force and muscle and orbital restrictions, which are required information for appropriate surgical planning.

Abducens Nerve↗
PubMed1981

The adjustable Harada-Ito procedure.

In four patients with superior oblique palsy, symptomatic excyclotorsion was present without a substantial vertical deviation. Surgery of anteriorizing and lateralizing the anterior fibers of the superior oblique tendon on an adjustable suture was performed (adjustable Harada-Ito procedure). the morning after surgery, adjustment of the suture was made to eliminate the torsional deviation. The suture was loosened when an overcorrection was present and was tightened when an undercorrection was present. Follow-up varied from two to 20 months. All patients remained free of torsional symptoms and no vertical deviation was induced. In addition, the eyes operated on had no limitation of elevation in adduction. The technique allows the surgeon to more exactly adjust the advanced fibers of the superior oblique tendon so as to minimize or eliminate the excyclotorsion and eliminate symptomatic complaints.

Adult↗
PubMed1981

Adolescent cystinosis: a clinical and specular microscopic study of an unusual sibship.

Six members of a sibship originally consisting of 8 offspring lived to teenage. Five of these developed the adolescent form of cystinosis. Since adolescent cystinosis is autosomal recessive, such a high incidence of affected members is of uncommon occurrence. Depending on whether the sibship size (n) is known as 6 to 8, it should occur only in approximately 1.5% or 5.8% of sibships of corresponding size. Specular microscopy was used to study the corneal stroma of all 3 of the living, affected members of this sibship and the conjunctiva of one of the siblings. Vivid, needle-shaped crystals were observed in the corneal stroma. Smaller, variably shaped crystals were observed in the conjunctiva. The crystals seen with specular microscopy fit the description of those studied with light and electron microscopy.

Adolescent↗
PubMed1980

A model for eye muscle surgery.

An inexpensive model for demonstrating and practicing strabismus surgery is described here. The figure-of-8 technique, adjustable rectus recession and resection surgery, and various types of conjunctival closure have been performed on the model. The model can also be helpful in demonstrating and practicing typical recession, resection, advancement, tucking, and marginal myotomy procedures to residents in ophthalmology.

Models, Structural↗
PubMed1980

Saccades with limited downward gaze.

Fourteen patients with monocular limitation of downward gaze had vertical saccadic velocity measurements. Patients with orbital floor fracture and endocrine ophthalmopathy were excluded from the group. In four cases (29%), the difference between upward downward saccadic velocities was 20% or less. These patients were not thought to have any evidence of inferior rectus muscle paresis. In ten cases (71%), the difference between upward and downward saccades varied between 46% to 275% (average, 115%), upward saccades being more rapid in each case. These cases were all believed to have moderate to great inferior rectus muscle palsy. In one subject with a lidocaine hydrochloride-induced inferior rectus muscle palsy, upward saccades were 135% faster than downward saccades. These findings were compared with those in patients with monocular limitation of elevation, and the surgical management was reviewed.

Electrooculography↗
PubMed1979

Double elevator palsy.

Of 15 patients with monocular limitation of elevation, six had no deviation in primary gaze while the remaining nine had hypotropia of the involved eye. Twelve of 15 patients had restriction to upgaze on forced duction testing. Eleven of these 12 had normal upward saccadic velocity, which suggested normal elevator function. Four patients had reduced saccadic velocity, which indicated true elevator weakness. Superior rectus muscle paresis alone could account for limited elevation and would reduce upward saccadic speed. Patients with a diagnosis of "double elevator palsy" only infrequently (about one quarter of cases) have palsy of an elevator muscle and may have only a single elevator palsy. The identification of a true elevator weakness is most important in planning management.

Electrooculography↗
PubMed1979

Adjustable suture strabismus surgery.

The adjustable muscle recession procedure is described. The criteria for patient selection are reviewed as well as the surgical results during the past 5 years when the technique has been in active use. The philosophy behind the adjustable suture technique is the following: a procedure which would allow the surgeon to bring ocular alignment to a favorable position at the time of the first postoperative dressing change would be of significant value. Adjustable suture surgery is just such a technique. It does not insure a successful result. The ophthalmologist must still decide upon the preferred eye position. The surgeon is merely allowed to come closer to his desired immediate postoperative alignment by the ability to adjust muscle position after surgery.

Adolescent↗
PubMed1979

Saccadic velocity measurements in Brown's syndrome.

Eleven patients with Brown's syndrome (12 eyes) had vertical saccades measured in the primary, adducted, and abducted positions. Upward saccades in all 3 positions were equal and within the normal average velocity range. There was no difference between upward velocities in the eyes with Brown's syndrome when compared with the opposite, normal eye. These findings are consistent with the restrictive etiology of Brown's syndrome and may be helpful in confirming the diagnosis in some patients.

Electrooculography↗
PubMed1978

The O'Connor cinch revisited.

The modified O'Connor cinch operation is a useful, but little used, adjustable resection operation. For increased understanding of its shortening and adjustment characteristics, a standard cinch was performed in animals and patients with strabismus. Animal studies showed that, as each strand of the cinch was removed, a small, relatively equal release of the cinch effect occurred. Measurement of the shortening obtained in patients with strabismus showed a consistent resection effect of about 4 mm. Review of 17 cases in which the cinch was used as part of the surgical treatment showed the technique to be adjustable by reducing the overcorrection in 6 cases. Ten to 20 prism dioptres of reduction in the deviation was obtained with adjustment of the cinch on the first postoperative day. All 17 cases had satisfactory adjustment. The largest residual deviation was 12 prism dioptres.

Adolescent↗
PubMed1978

Saccadic velocity studies in Möbius syndrome.

Eight patients with Möbius syndrome were examined and their eye movements studied with horizontal saccadic velocity measurements. A marked decrease in velocity of horizontal saccades was noted, indicating both medial and lateral rectus weakness. Significant esotropia, when present, may be improved with conventional recession-resection surgery.

Abnormalities, Multiple↗
PubMed1977

The treatment of A and V patterns by monocular surgery.

Eleven patients with "A" or "V" pattern strabismus and the absence of notable oblique muscles overactions, were operated on, using the technique of monocular vertical displacement of the horizontal rectus muscles. The average correction of the A or V pattern was 16.5 delta. Subjective torsional complaints were not reported by any of the patients. Torsion was measured postoperatively with the Maddox rod, Maddox wing, and amblyoscope. The average torsional measurement, at least one month postoperatively, was 1.6 degrees with a range of 0 degrees to 7 degrees. It was concluded that monocular vertical displacement of the horizontal rectus muscles can result in satisfactory correction of the A or V pattern and produces no substantial postoperative torsional symptoms or substantial measured torsion at both distance and near fixation.

Humans↗
PubMed1977

Adjustable rectus muscle recession surgery. A follow-up study.

Fifty-six patients underwent an adjustable rectus muscle recession procedure. This procedure permits the surgeon to enhance or diminish the amount of muscle recession on the evening after surgery or the first postoperative day if cover-testing indicates an inappropriate amount of undercorrection or overcorrection. The adjustable rectus muscle recession technique seems to be a practical and effective means to change the strabismic deviation postoperatively. The procedure requires patient cooperation and is most suitable for patients age 15 years and older. The procedure has been effective in altering the angle of deviation, and this alteration has been stable during the follow-up period in most cases. In this initial series, the reoperation rate was low, postoperative alignment was excellent, and complications were minimal.

Adolescent↗