[Oculomotor equilibrium and accommodation-convergence].
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Biomedical subjects
Publications and source records attributed to M A Quéré.
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A recording technique is essential in the study of ocular movements. At present, numerous mechanical, optical and electrical methods are under review. Kinetic electro-oculography is at the moment the only available technique which fulfills most clinical requirements. However, it is a delicate method, subject to numerous hazards; the sources of errors are manifold. With electro-oculography, we can only expect a qualitative and comparative assessment of horizontal movements. Displacements along the oblique axes cannot be studied.
Work carried out by Cüppers has proved that squint deviations are related to the innervational and viscoelastic impairments of th ocular muscles, whose association and degree vary according to each case. The passive duction test is always positive in retraction syndromes, but it is not precise enough to detect most of the viscoelastic impairments of functional squints. The authors have noted important and frequent anomalies of muscle stretching; they describe the operative features of a muscle elongation test in various types of strabismic deviations.
Study of the muscle elongation test in 211 patients with convergent squints who never have been operated on previously reveals that about 35% of cases display abnormal muscle stretching; 48 cases retain a lasting anesthetic angle in spite of a normal elongation test. Particularly significant correlations exist between a positive muscle elongation test and the degree of clinical oculogyric spasm, electro-oculographic motor impairments, squint deviation degrees, and age at strabismus onset. All these correlations prove that viscoelastic anomalies of the ocular muscles are secondary to supranuclear innervational impairments. In addition, both together have an asymmetrical degree on each eye in more than half the cases. The authors conclude that, in order to choose the correct surgical procedure, the results of the anesthetic and muscle elongation tests must be taken into account.
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(1) In functional squints, it is necessary to assess, in each case, the exact and particular role played by innervational and viscoelastic impairments by carrying out a thorough clinical examination, an electro-oculographic recording and the anesthetic and muscle elongation tests. Such as appraisal is still only approximate, however. (2) Various surgical methods permit the suppression of the deviation but all the procedures are purely empirical, and their results have no pathogenetic significance. Moreover, all the surgical actions cause some muscle and health scarring. For all these reasons, a high rate of success of one-step surgery is not possible. (3) An accurate appraisal of motor balance and, in particular, of the sensory state is very difficult. It can only be achieved by successive controls over a long period of time. Early surgery has many substantial drawbacks. The adjustable-suture technique is very tempting, but the lack of cooperation of most young children renders it use difficult.
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