Biomedical subjects
Publications and source records attributed to J A Thalacker.
41 patients with acquired esotropia who did not have preoperative prism adaptation were compared to 50 patients who were prism-adapted prior to surgery. Surgical success was evaluated at a postoperative period of 6 months. 82% of the patients who responded to prism adaptation had a successful surgical result as compared to only 51% of the patients who did not wear prisms preoperatively.
Thirty-two eyes of 31 patients received superior rectus recessions for the treatment of dissociated vertical deviation (DVD). All patients were followed for a postoperative period of at least six months, and 50% were followed for a period of three years or more. The differential diagnosis of DVD and inferior oblique overaction was important, and the distinguishing features of each are mentioned. A distinction was made between occlusion hyperphoria, a latent deviation in the preferred fixating eye, and DVD, a manifest deviation in the nonpreferred eye. In the vast majority of cases, a unilateral superior rectus recession of graduated amounts was performed in the eye with a cosmetically unacceptable DVD. The surgical "hang loose" technique permitted avoiding technically difficult situations. After operation 82% of the eyes were aligned, within the good to excellent categories (0-9 prism diopters).
Twenty-five patients with thyroid myopathy were referred to our Strabismus Clinic for treatment of diplopia. Prism treatment was effective in only three. When the remaining 22 patients' ocular motility problems and thyroid states were stable, surgical management was undertaken. The preoperative evaluation included visual fields, iris angiograms, binocular diplopia fields, intraocular pressures in different positions of gaze and A-scan echography. The goal of surgery was to produce as large a binocular visual field from primary as possible. Supramaximal recessions of the involved muscles were often needed and adjustable sutures were an important part of the surgical management. The complications encountered included limitation of movement into the field of the recessed muscle, inducement of an A-pattern in downgaze, and postoperative instability.