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M Gräf

Publications and source records attributed to M Gräf.

At least 19 recordsLinked to original sources
PubMed2006

[Landolt C and snellen e acuity: differences in strabismus amblyopia?].

BACKGROUND: Assessment of visual acuity depends on the optotypes used for measurement. The ability to recognize different optotypes differs even if their critical details appear under the same visual angle. Since optotypes are evaluated on individuals with good visual acuity and without eye disorders, differences in the lower visual acuity range cannot be excluded. In this study, visual acuity measured with the Snellen E was compared to the Landolt C acuity. PATIENTS AND METHODS: 100 patients (age 8 - 90 years, median 60.5 years) with various eye disorders, among them 39 with amblyopia due to strabismus, and 13 healthy volunteers were tested. Charts with the Snellen E and the Landolt C (Precision Vision) which mimic the ETDRS charts were used to assess visual acuity. Three out of 5 optotypes per line had to be correctly identified, while wrong answers were monitored. In the group of patients, the eyes with the lower visual acuity, and the right eyes of the healthy subjects, were evaluated. RESULTS: Differences between Landolt C acuity (LR) and Snellen E acuity (SE) were small. The mean decimal values for LR and SE were 0.25 and 0.29 in the entire group and 0.14 and 0.16 for the eyes with strabismus amblyopia. The mean difference between LR and SE was 0.55 lines in the entire group and 0.55 lines for the eyes with strabismus amblyopia, with higher values of SE in both groups. The results of the other groups were similar with only small differences between LR and SE. CONCLUSION: Using the charts described, there was only a slight overestimation of visual acuity by the Snellen E compared to the Landolt C, even in strabismus amblyopia. Small differences in the lower visual acuity range have to be considered.

Adolescent↗
PubMed2006

[Ocular neuromyotonia].

BACKGROUND: Ocular neuromyotonia is a rare ocular motility disorder characterized by involuntary contractions of one or several ocular motor muscles. In this report a typical case is presented. PATIENT AND METHODS: A 61-year-old female patient was referred with persistent diplopia despite previous surgical treatment for right 6 (th) nerve palsy. The palsy was caused by a meningeoma of the petrous bone, which had been incompletely resected. Subsequently, the patient had received radiation therapy. Strabismological and neuroophthalmological examinations were performed. The results coincide with data collected in our department from three other patients with ocular neuromyotonia (2 cranial nerve VI, 1 cranial nerve IV), over the past three years. RESULTS: The patient showed orthophoria at distance (5 m) and an exophoria of 6 degrees at near vision. The abduction and adduction of the right eye were restricted to 40 degrees and 35 degrees , respectively. After several seconds of eccentric gaze to the right, the right eye remained in an abducted position of approximately 25 degrees . The gaze to the left led to a retraction instead of an adduction of the right eye. The spasm of the lateral rectus muscle resolved after some seconds, returning to the aforementioned right eye motility. Under oral treatment with carbamazepine, initially 200 mg, later increasing to 400 mg per day, the symptoms improved significantly, did not resolve entirely, however. CONCLUSIONS: These typical findings permit the diagnosis of ocular neuromyotonia. The characteristic symptoms of ocular neuromyotonia and the typical history of a previous intracranial tumor, treated neurosurgically with adjuvant radiotherapy, lead to the hypothesis that ephaptic transmission in the cranial nerve is the underlying pathophysiological mechanism in the development of ocular neuromyotonia. Hereby, efferent impulses from non-twitch motoneurons could activate neighbouring axons, and spread both peripherally and centrally. Beside other mechanisms discussed, an involvement of proprioceptive elements and their reafference is also a possible cause for the prolonged muscle contraction.

Abducens Nerve Diseases↗
PubMed2006

[Systemic bias in the photographic assessment of the first purkinje image].

BACKGROUND: The growing popularity of digital imaging leads to an increasing number of photos transferred by parents via E-mail to an ophthalmologist, showing a child with a displacement of corneal reflections. This must not necessarily lead to the diagnosis of manifest strabismus. MATERIALS AND METHODS: The displacement of the first Purkinje image is demonstrated by moving the flash of a digital camera sideways from the objective. Photographs were taken at a distance of 0.6 m while the healthy test subject was looking into the camera. Flashlight was displaced gradually up to 20 cm to the left side of the objective. The resulting displacement of the corneal reflections was measured after transferring the photos to a computer. RESULTS: Displacement of the source of light by 10 cm resulted in a displacement of the first Purkinje image of about 1 mm, i. e., about 0.1 mm per degree. CONCLUSIONS: Displacement of corneal reflection was 0.1 mm per degree. Asymmetry of corneal reflections is twice as much, since the corneal reflections are displaced in the same direction on both eyes. Lateral displacement of the flash from the objective of the camera by 2.5 cm results in an asymmetry of 0.5 mm, thus suggesting a squint angle of 6 degrees. Vice versa, a real strabismus can be masked. This bias can be avoided by using the camera with the flash above the objective in relation to the patient's interpupillar axis. Nevertheless, it is impossible to diagnose or to exclude a microstrabismus by this method itself, because an angle kappa, if it is different on both eyes, can also mimic or mask a manifest strabismus.

Artifacts↗
PubMed2005

[Head-tilt test in unilateral and symmetric bilateral acquired trochlear nerve palsy].

BACKGROUND: The head-tilt phenomenon (difference between the vertical deviations with an ipsilateral and contralateral head-tilt by 45 deg. each) occurring in patients with a superior oblique palsy has traditionally been explained by the lacking contraction of the superior oblique muscle within the synkinetic movement of ocular counterrolling. However, using a computer model, Robinson showed that the superior oblique palsy itself causes only a relatively small head-tilt phenomenon. Adaptive mechanisms amplifying the otolith reflex were suggested to explain the increase of the head-tilt phenomenon in the course of time. In order to reduce the abnormal head posture required for binocular vision, the otolith reflex would be amplified, accepting the greater vertical deviation when the head is tilted to the paretic side . QUESTION: If the head-tilt phenomenon were solely caused by the lacking contraction of the superior oblique muscle, it should be greater in bilateral than in unilateral superior oblique palsies. If an adaptive mechanism were acting to reduce the abnormal head posture, the head-tilt phenomenon should not be greater, and could even be smaller in bilateral than in unilateral superior oblique palsy, because in bilateral (symmetric) trochlear nerve palsies the vertical deviation at straight gaze is already small or absent without adaptation. PATIENTS AND METHODS: We have carried out a retrospective comparison of 10 patients with bilateral symmetric superior oblique palsies and 10 patients with unilateral superior oblique palsy. In all cases, the palsy was acquired and had been present for at least 1 year. RESULTS: The patients with bilateral superior oblique palsy had a head-tilt phenomenon ranging from 0 to 7 degrees (median, 2 deg.). The patients with unilateral superior oblique palsy had a head-tilt phenomenon between 2 and 13 degrees (median, 8 deg.). The difference was significant (p = 0.0117). CONCLUSIONS: The head-tilt phenomenon is smaller in long-standing bilateral symmetric superior oblique palsies than in long-standing unilateral superior oblique palsy. This finding supports the hypothesis that in unilateral superior oblique palsy, an adaptive mechanism augments the head-tilt phenomenon by an amplification of the otolith reflex. However, we presume that the amplification of the otolith reflex is only a side effect of the adaptive change of the vertical fusional vergence tonus and thus the price of the improved vertical fusion, rather than a compensatory mechanism.

Adaptation, Physiological↗
PubMed2005

[Results of surgery for congenital Brown's syndrome].

BACKGROUND: There are various surgical procedures for the treatment of congenital ("true") Brown's syndrome. We have evaluated the effects of a superior oblique tendon recession. PATIENTS AND METHODS: In a retrospective study, we evaluated the files of 22 patients who received surgery for congenital Brown's syndrome in our department. A recession of the superior oblique tendon was performed, when there was a hypotropia in primary position with an abnormal head posture and a significant elevation deficit in adduction, and when these findings did not improve spontaneously. The squint angles (alternate prism and cover test), the monocular motility and the abnormal head posture at distance fixation were assessed. The measurements were performed 1 day before and 3 months after surgery. Thirteen patients were examined 2 - 10 years after surgery. RESULTS: At the time of surgery, the patients were 4 - 17 years old (median 7 years), 13 were male, in 15 patients, the right eye was concerned. Eight patients had an additional esotropia, one patient was exotropic. The vertical deviation in straight gaze was 0 - 12 deg (median 7 deg). The elevation of the eye was restricted to - 10 deg (below horizontal) to 15 deg (median 0 deg) in adduction and to 10 - 35 deg (median 25 deg) in abduction. Sixteen patients had an abnormal head posture. The superior oblique tendon was recessed by 10 mm, in some patients with an additional loop (6x0 polyester). Nine patients received simultaneous surgery for their eso/exotropia. At the end of the operation, the elevation of the eye in adduction (forced duction test) was free. Three months postoperatively, the vertical deviation was 0 - 6 deg (median 1 deg). Twelve patients did not show any abnormal head posture. Inspite of free passive motility, the monocular elevation in adduction was only slightly improved to - 5 to 15 deg (median 5 deg). At the late control, the hypotropia (0 - 4 deg, median 0 deg) and the elevation in adduction (5 - 35 deg, median 15 deg) were significantly improved. CONCLUSION: The recession of the superior oblique tendon is an effective and safe surgical procedure for congenital Brown's syndrome. The efficiency of the procedure is individually variable. Presumably, this variability was caused by the heterogenous etiology of Brown's syndrome rather than by surgical technique. The hypotropia and the abnormal head posture were reduced immediately after surgery, while the delayed improvement of active elevation in adduction often remained incomplete. Postoperative forced upgaze training may be beneficial.

Adolescent↗
PubMed2004

[Dissociated near reflex and accommodative convergence excess].

We report on an 8-year-old boy whose near reflex could be elicited exclusively when the left eye was fixing (LF) but not when the right eye was fixing (RF). With RE +1.25/-1.25/169 degrees and LE +1.0/-0.75/24 degrees, the visual acuity was 1.0 OU at 5 m and RE 0.5, LE 1.0 at 0.3 m improving to 1.0 OU by a near addition of 3.0 D. Stereopsis was 100 degrees (Titmus test). The prism and cover test revealed an esophoria of 4 degrees at 5 m. At 3 m there was an esophoria of 6 degrees (RF) and an esotropia of 28 degrees (LF), compensating to an esophoria of 3 degrees (RF/LF) with a near addition of 3.0 D. Accommodation and the pupillary near reaction (OU) were hardly elicitable during RF. During LF, retinoscopy revealed an accommodation of 8 D (OU) and the pupils constricted normally. Correction by bifocal glasses yielded orthotropia with random dot stereopsis at near.

Accommodation, Ocular↗
PubMed2004

[Problems for ophthalmologists in the certification of blindness ].

BACKGROUND: We compared the medical test results of 117 persons examined by the superintendent for blindness assessment in 2002 with their certificates of blindness (5.5% of the applications, 42% of the testimonial examinations performed in Hessen in 2002). METHODS: If the ratings as "blind" or "severely visually handicapped" (corresponding to a visual acuity of not more than 0.02 or 0.05, resp.) differed between the medical test and the certificate, visual acuity, visual field, further findings, and the methods of assessment were analyzed on the basis of the medical records. RESULTS: The medical test confirmed 75 certificates. Fourteen persons with a certificate of blindness were graded as severely visually handicapped by the medical test. In 8 and 12 cases, respectively, the criteria of neither blindness nor severe visual handicap were fulfilled. Eight persons with a certificate of severe visual handicap were graded as blind by the medical test. DISCUSSION: In 29% of the cases, the visual handicap did not reach the certified grade. Striking differences occurred between the certificate and the functions shown in the medical test. In the certificates, the declared visual handicap was regularly judged to correspond to the objective findings, but apparently in these cases symptom validity had not been critically assessed. An improvement of diagnostic validity could be achieved using relatively uncomplicated subjective and objective tests.

Adolescent↗
PubMed2004

[Strategies of visual acuity assessment].

Visual acuity can be assessed by different strategies. The constant-stimulus-, the stair-case-, the Best-PEST-strategies, and the EN ISO 8596 are discussed. In cases of presumed psychogenic visual impairment and malingering it can be useful to modify these strategies striving for a determination of the (minimum) visual acuity based on statistical analysis rather than "clinical experience". The EN ISO 8596 defines visual acuity by a 60 % criterion, thus implying guesswork, if recognition of the optotypes is uncertain. Therefore, the forced-choice-procedure is mandatory. Objective psychophysical (preferential looking, induction or suppression of rhythmic eye movements) and electrophysiological methods (VEP) of visual acuity assessment can be useful in infants, in the mentally handicapped, and in patients with presumed psychogenical influence or malingering.

Data Interpretation, Statistical↗
PubMed2004

[Presentation of visual acuity in ophthalmological publications].

BACKGROUND: Visual acuity is one of the most important functions of the visual system. Visual acuity is the basis of many decisions in clinical practice. The assessment of visual acuity is clearly defined (norm EN ISO 8596). In this study, the presentation of results of visual acuity assessments in the ophthalmological literature was analysed. MATERIALS AND METHODS: All the issues of the journals "Klinische Monatsblatter fur Augenheilkunde" and "Der Ophthalmologe" of the years 2002 and 2003 were reviewed especially concerning the procedure of visual acuity assessment, the scaling in the lower visual acuity range, axis scaling and the calculation of mean values of visual acuity. RESULTS: In total, 550 publications were reviewed. Of these papers, 207 contained at least one visual acuity value and 42 papers presented detailed data concerning either the change of visual acuity over a certain time interval, or mean values, or using charts. A linear scale was used in 9 of 28 papers with presentation of visual acuity measurements in a chart. Of 32 publications with visual acuity measurements less than 0.2, only 2 used a logarithmic scale in the lower visual acuity range, while in 14 papers, scaling was rather rough or not numeric (e. g., counting fingers). Sixteen papers used the units "finger counting" or "hand movements" to describe low visual acuities. The way of calculating mean values remained obscure in 36 papers. CONCLUSIONS: Regarding a correct assessment of visual acuity and the effect of therapy, the fundamental guidelines of visual acuity assessment and its correct presentation should be considered.

Humans↗
PubMed2002

Kestenbaum and artificial divergence surgery for abnormal head turn secondary to nystagmus. Specific and nonspecific effects of artificial divergence.

Recommendations concerning the kind and dosage of eye muscle surgery for nystagmus vary in the literature. The present paper is an evaluation of the effects of Kestenbaum and artificial divergence surgery on abnormal head posture in a retrospective study. Exclusively patients with surgery for nystagmus-related horizontal head-turn (HT), with binocular vision and without previous eye muscle surgery were considered. Of the 78 patients, aged 3 to 68 years, 52 had a HT to the left side; 47 patients were male. In the Kestenbaum group (n = 31), the preoperative HT of 30 degrees (20-40) (median, 0.1-0.9 quantile) was reduced to 10 degrees (0-30) by surgery of 14 mm (10-20) on each eye. Four patients received further surgery. In the artificial divergence group (n = 27), the HT of 30 degrees (25-40) was reduced to 5 degrees (0-20) by recess-resect surgery of 10 mm (7-12) on the adducted eye. Seven patients needed further surgery. In the combined Kestenbaum plus artificial divergence group (n = 20), the HT of 30 degrees (25-40) was reduced to 7 degrees (-5-15) by surgery of 29 mm (21-37) on both eyes together. No further surgery was necessary. Kestenbaum surgery had a similar effect/dose ratio as recess-resect surgery for strabismus. If a test with base-out prisms suggests that artificial divergence is promising, this concept is preferable. It can be integrated into Kestenbaum surgery.

Adolescent↗
PubMed2001

Surgery for nystagmus related head turn: Kestenbaum procedure and artificial divergence.

PURPOSE: An abnormal head posture adopted to reduce a nystagmus can be treated by Kestenbaum surgery or by creating an exodeviation which is compensated by convergence (artificial divergence). We evaluated the effects of Kestenbaum surgery and artificial divergence surgery in a retrospective study. METHODS: Seventy-eight patients who received surgery for horizontal head turn (HT) due to nystagmus were included in the study. Exclusion criteria were previous extraocular muscle surgery, strabismus, lack of binocular vision, and cerebral disease. The millimetres of surgery and the findings before and 3 months after operation [HT, binocular visual acuity (VA), binocular vision (BV)] were evaluated. The patients were divided into three groups: the Kestenbaum group, the artificial divergence group, and the artificial divergence plus Kestenbaum group. RESULTS: Of the 78 patients, aged 3-68 years, 52 had HT to the left side and 47 were male. In the Kestenbaum group (n=31), the median (10% and 90% quantile) HT was 30 degrees (range 20-40 degrees). A total of 28 mm (range 20-40 mm) surgery reduced the HT to 10 degrees (0-30 degrees). The efficacy of surgery was 1.4 degrees HT reduction per millimetre surgery on one eye (range 0.4-2.5 degrees). Four patients received further surgery. In the artificial divergence group (n=27), 10 mm (range 7-12 mm) surgery reduced the HT of 30 degrees (range 25-40 degrees) to 5 degrees (range 0-20 degrees). Seven patients received further surgery. In the artificial divergence plus Kestenbaum group (n=20), the HT was 30 degrees (range 25-40 degrees). A total of 29 mm (range 21-37 mm) surgery reduced the HT to 7 degrees (range -5 degrees to 15 degrees). No further surgery was performed. Postoperatively, the maximum VA and BV was available without large HT, but an increase in the absolute VA and BV could not be proved. CONCLUSION: Artificial divergence is preferable or should be combined with Kestenbaum surgery, if possible. Kestenbaum surgery alone has an effect/dose ratio similar to recess-resect surgery for strabismus. Thus, to correct x degrees HT, 2/3x mm surgery on each eye is adequate.

Adolescent↗
PubMed2001

[Results of combined divergence operation in intermittent exotropia in 120 children].

BACKGROUND: Intermittent exotropia is the most frequent indication for surgical correction of exodeviations in childhood. Overcorrection with prolongated or persistent consecutive esotropia can impair binocular vision particularly in early childhood. We wanted to investigate this potential risk and the dose/effect relation of recess-resect surgery on children. PATIENTS AND METHODS: 120 children up to ten years of age underwent recess-resect surgery for intermittent exotropia in our clinic from 1991 to 1999 (< 2% of the surgical cases). The cycloplegic refraction was spectacle corrected with a reduction of 0.5 dpt. Preoperatively, a diagnostic occlusion was performed for three days. The amount of surgery was calculated using our dosage schedules based on effects one week postoperatively. The squint angles as measured by the alternate prism and cover test at 5 m and 0.3 m pre- and 3 months postoperatively and the binocular functions as measured by the Bagolini striated glasses, Titmus, Randot, TNO, or Lang tests were evaluated. RESULTS: (Medians) Squint angles in primary position were: preoperative: distance (5 m)--15 degrees, near (0.3 m)--16 degrees; postoperative (n = 104); distance--4 degrees, near--3 degrees. Effectivity of surgery: distance: 1.3 degrees/mm, near 1.4 degrees/mm. Consecutive esotropia requiring surgical correction occurred in 1 child. Second surgery for intermittent exotropia in the years 1991 to 1999 was necessary in 5 children. Binocular functions (n = 95): Preoperative = postoperative: 61%, postoperative > preoperative 21%, postoperative < preoperative 18%. The diagnostic occlusion was helpful to differentiate "pseudo-divergence excess type" from "divergence excess type" exotropia. The average deviation did not increase under the diagnostic occlusion. The effectivity of surgery (degree/mm) in the children group was lower than in a compared group of older patients (> 10 years) with intermittent exotropia. CONCLUSION: Using our own dosage schedules and surgical technique, residual exodeviations are common after recess-resect surgery in childhood. The risk of consecutive esotropia or persistent impairment of binocular vision is low.

Child↗
PubMed2001

[Unilateral aplasia of a lateral rectus muscle].

BACKGROUND: The congenital absence of an extraocular muscle is rare. The case of an unilateral lateral rectus muscle and a review of the literature are presented. PATIENT AND METHODS: A healthy 7-year old boy with inconspicuous family history was seen in our clinic. The boy had been noted to have a right esotropia from infancy. Clinical orthoptical examinations and magnetic resonance imaging (MRI) were performed. The esotropia was corrected by transposition of the superior and inferior rectus muscle. RESULTS: With correction of the myopic astigmatism the visual acuity of either eye was 0.8. The right eye could not abduct to pass the midline, the left eye passed the midline by 35 degrees. From the primary position the right eye was able to elevate by 20 degrees and the left eye to elevate 15 degrees. The alternate prism and cover test showed in either eye fixation an esotropia of 24 degrees without significant change in elevation or depression. Besides, there was a hypertropia (+VD) of 14 degrees which increased to 21 degrees in left gaze and decreased to 0 degree in right gaze. Indirect ophthalmoscopy showed a bilateral excyclo position of approximately 5-10 degrees. Retraction of either eye was not seen in any gaze direction. The axial length of the right/left eye was 25.2 mm/24.6 mm. Aplasia of the right lateral rectus muscle and hypoplasia of the left lateral rectus muscle could be demonstrated by magnetic resonance imaging. Intraoperatively the right lateral rectus muscle was absent. The vertical eye muscle inserted regularly. Hummelsheim's procedure was performed. Eight months postoperatively, the boy was orthotropic in primary position. The inferior oblique overaction was still present together with a "V" pattern of 8 degrees. The Bagolini test was positive. CONCLUSION: The congenital absence of one or more extraocular muscles is a rare condition, which has to be considered as a differential diagnosis to neurogenic nerve palsy.

Child↗
PubMed2001

[Dissociated horizontal deviations (DHD): nomenclature and etiology. An orientating attempt in terminological confusion].

PURPOSE: To classify dissociated horizontal deviations (DHD) based on the etiology of the vergence that causes the dissociation of the squint angle. METHODS: Dissociated strabismus can reliably be diagnosed by a change of the squint angle caused by an alternation in the fixation from one eye to the other, when all the other conditions (head posture, direction of gaze, fixation distance, accommodation) remain unchanged. The decisive diagnostic tool is the reversed fixation test: During monocular fixation with one eye, the squint angle of the other eye is neutralized using a synoptometer or a prism. Then, the fixation is changed to the other eye, which keeps its position behind the prism. If the change in fixation causes a change in the position of the previously fixating eye, the deviation is dissociated. If the position of the previously fixating eye does not change, the deviation is not dissociated. RESULTS: Dissociated strabismus can be detected and differentiated from both comitant and incomitant non dissociated strabismus by the reversed fixation test. The dark red glass test is less sensitive and less specific for dissociated strabismus than the reversed fixation test, if a difference in accommodative convergence is excluded, possible causes of DHD are nystagmus-attenuating convergence, substitution of version eye movement by convergence, and a horizontal side effect of the vertical eye muscles in asymmetric DVD. CONCLUSION: Dissociated strabismus is an effect of vergence which is brought about by the change in the fixation or dominance from one eye to the other eye or in the interocular ratio of afferent input (luminance). Dissociated strabismus can be classified based on its direction or due to its etiology.

Diagnosis, Differential↗
PubMed2001

[The closed Landolt ring--a handy test for evaluating suspected simulation].

PURPOSE: We present a visual acuity test for proof of malingering and psychogenic impairment of visual acuity. METHOD: The book contains 36 plates. On 32 plates, a Landolt-C is shown with a gap of 10 minutes of arc, thus corresponding to a visual acuity of 0.1, when applied at a distance of 1 metre. Each of the 4 alternatives of the Landolt-C occurs eight times in random order. Starting at position 21, four plates are interspersed showing a closed circle of the same size. The test is used at a distance corresponding to an acuity level of maximum 50% of the presumed factual acuity. Following a four alternative forced choice paradigm, the tested person is requested to call the direction of the Landolt-C within about 2 seconds, when the plates of the book are turned over. The responses and their latency are recorded using a digital electronic system which allows later audiovisual analysis. The response on the first closed circle and its latency is compared to the previous responses. Two subjects were tested who tried to pretend a reduction of their visual acuity. RESULTS: Malingering was proved by the verbal response of the first subject and by the long latency of the response of the second subject (4.0 s vs. 1.2 s-2.7 s for the previous responses). The entire test, explanation included, took less than 5 minutes. CONCLUSION: This handy test can be a useful tool in cases suspect of malingering or psychogenic impairment of visual acuity.

Adult↗
PubMed2000

[Healing process and complications after eye muscle surgery].

BACKGROUND: Varying reports on the incidence of operative and postoperative complications following eye muscle surgery have been published. The purpose of this study was to quantify complications after various types of eye muscle surgery as well as minor pathological changes of the anterior and posterior segment. PATIENTS AND METHODS: This prospective study included all patients who underwent eye muscle surgery at the Department of Strabismology and Neuroophthalmology, Giessen, from January to May 1998. Five hundred eyes of 377 patients aged 2-82 years were included. The spectrum of procedures comprised: recessions, resections, tucks, R&R procedures, transpositions, bimedial retroequatorial myopexies, and revisions of rectus and oblique muscles. All patients were examined 1 day preoperatively and 1 day, 1 week, and 3 months postoperatively. Any complications and even minor pathological changes of the anterior and posterior segment were documented. Some changes were assessed by means of a score (0-3). RESULTS: One day postoperatively, 30% of eyes had inflammatory pseudoptosis, most of them mild. Conjunctival swelling and injection were frequently mild and moderate, after 1 week mostly mild. Conjunctival irritation was more pronounced following resection than tucking. Punctate epithelial keratopathy was noted in 1.6% of cases (first postoperative day), dellen in 4.3% (first postoperative week). Three months postoperatively, 14.3% of eyes had biomicroscopically visible conjunctival folds and 91.3% had minimal conjunctival scars. None of the patients had a scleral perforation or other serious complication. CONCLUSIONS: Eye muscle surgery rarely entails complications. Revisions due to organic pathological changes are extremely rare. Possible development of dellen requires check-up 4-7 days postoperatively. Tucking of rectus muscles causes less conjunctival irritation than resection.

Adolescent↗
PubMed2000

[Pathophysiology, diagnosis and therapy of three congenital dacryocystoceles].

BACKGROUND: Congenital dacryocystocele has been rarely described in German literature. Congenital obstruction and distention of the lacrimal sac makes it necessary to differentiate for various causes. PATIENTS AND METHODS: Three infants had congenital dacryocystocele. The diagnosis was made by sonography and was established by probing the lacrimal duct and nasal endoscopy that showed a white prominent tumor below the lowest conch. RESULTS: Directly after endonasal and canalicular opening of the dacryocystocele clear liquid with white detritus drained, and the swelling decreased. No further procedure was needed. CONCLUSION: The diagnosis of dacryocystocele can be made by inspection, probing the lacrimal duct, ultrasound and nasal endoscopy. If probing of the lacrimal duct could not easily open the Hasner's membrane, endonasal opening can be performed. The cooperation with an ear-nose-throat specialist could lead to the diagnosis of dacryocystocele and sufficient treatment without the need for any further radiological examinations.

Dacryocystitis↗