Biomedical subjects
Publications and source records attributed to N Stärk.
There is a good chance to reduce the scaring between conjunctiva, Tenon's capsule, muscle and sclera after surgical treatment of rectus and oblique muscles if a careful reconstruction of Tenon's capsule is made. In the rare cases that you have to reoperate, you will experience the benefit of these additional stitches (7-0 vicryl) that restore the integrity of Tenon.
The superior oblique tenotomy and tenectomy is an very effective and predictable surgical method in correcting the A-pattern in strabismus when overaction of one or both superior oblique muscles is present. In this series of 42 patients with an A-pattern an average correction of 86 to 91% was obtained regardless of the degree of the A-pattern. So we didn't observe any case that was converted from an A- to a serious V-pattern as obviously a less reduction is obtained in lesser degrees of A-pattern. In 11 cases of true but atypical Brown's-syndrome the tenotomy of the superior oblique muscle had a very beneficial effect on the limited movement of the affected eye and a co-existing abnormal head posture.
The present paper reports on 370 strabismic patients who underwent surgery after they had reached visual adulthood (ages 9-81). Surgery was performed for 183 exodeviations (50%), 139 esodeviations (37%) and 48 hypertropias. Patients desiring cosmetic improvement formed the largest group (172 cases, 46.5%). Most of these patients had been suffering from neglected concomitant heterotropias since childhood, but 17% attained subnormal binocular vision. To assess the risk of diplopia preoperatively, the deviation was fully corrected with prisms. Although intolerable persistent postoperative diplopia is a very rare event, the risk of this complication must be clearly pointed out to all visually adult patients. Apparently most adults, even those who have an anomalous retinal correspondence, respond as necessary to the new position of the eye and learn to ignore, suppress or fuse an initial postoperative diplopia. The best surgical results, in terms of restoration of binocular vision, were obtained in cases of intermittent exotropia and manifest exotropia without amblyopia.
A representative sample of 800 patients was taken from 15,000 children treated between 1972 and 1984 in the Department of Pediatric Ophthalmology of Frankfurt University Eye Hospital. Their charts were reviewed to answer two questions: what are the most frequent reasons for ophthalmological examination in children under 15 years old and what are the most frequent diagnoses? Ophthalmological examinations were most frequently scheduled because of strabismus, errors of refraction and trauma or inflammation of the anterior segment, though also in a large number of cases because of general diseases, most often neurologic diseases such as epilepsy or elevated intracerebral pressure. The diseases diagnosed ophthalmologically were classified as congenital or acquired eye diseases and congenital or acquired general diseases with ocular symptoms. The most frequent are indicated in the text. Acquired diseases were more frequent than congenital diseases, though this group proved to be much larger in pediatric patients than in adult patients.
Explore the source record for details and available documents.
Aside from hereditary juvenile macular dystrophy (Stargardt's disease), the author observed a significant increase in the incidence of spheric and astigmatic refractive errors in a further six hereditary or congenital deformities with poor vision. A shift toward myopia was seen in cases of coloboma, both of the optic nerve head as well as of the macular region, and in cases of macular aplasia and hypoplasia. A shift toward hyperopia was found in complete and ocular albinism, in retinitis pigmentosa and congenital achromatopsia. This hyperopic shift is in contradiction to the hypothesis that myopia can be deprivation-induced. It is assumed that a disturbance of visual stimulation early in life can disrupt emmetropization and thus induce the eye to become either myopic or hyperopic, in combination with a high incidence of astigmatism. This disturbance of visual stimulation may be due to clouding of the dioptric media, though equally to congenital or hereditary defects in the retina or the visual pathways of visual cortex.
During the last 3 years (1983 to 1985) accurate measurements of the distance between rectus muscle insertions and the corneal limbus were made on strabismus patients during surgery. After dissection of a muscle the distance from the posterior limbus (gray-white line) to the insertion line of the muscle was measured with calipers both at the midpoint and at each end of the insertion. A limbal incision was employed without exception. Statistical analysis was performed on a personal computer, using the Lotus 1-2-3 program. In contrast to the traditionally popular values determined by Fuchs, which are already over 100 years old (in parentheses), we found the following mean values: medial rectus insertion 4.5 mm (5.5), in 675 eyes operated on; inferior rectus insertion 5.67 mm (6.5), in 22 eyes operated on; lateral rectus insertion 6.20 mm (6.9), in 493 eyes operated on; and superior rectus insertion 6.64 (7.7), in 21 eyes operated on. The reasons for these differences are discussed. Because of the large size of the samples for the horizontal muscles it was possible to narrow down the confidence limits for the true mean values considerably; however, it is clear from the great differences between the lowest and highest values observed that the distance from the muscle insertions to the corneal limbus varies widely.
Of 246 systematically screened prematurely born infants, the majority with high neonatological risk, 12 developed a retinopathy of prematurity of at least Stage 3 according to the international classification of 1984, and underwent transconjunctival cryocoagulation. At a follow-up examination at age 6 months and later, there were no retinal changes apart from coagulation scars in 7 of the treated eyes; in 7 eyes slight connective tissue proliferations were seen (stage 1 cicatrization), in 4 eyes peripheral connective tissue proliferations with macula traction (stage 2 cicatrization), and stage 4 or 5 cicatrization in 2 eyes each. Five eyes were myopic, 2 of them severely so, and 4 eyes had a positive gamma angle. Unfavorable prognosis was indicated by a large avascular zone, preoperative stage 4, and early occurrence and rapid progression of retinopathic stages.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Fifty-four consecutive surgical cases of congenital ptosis were carefully evaluated to determine the incidence of refractive errors, strabismus and amblyopia. Of these patients, 70% had a refractive error, 43% had an astigmatism of more than 1.0, 55% had anisometropia, 27.5% had concomitant squint and 50% amblyopia.
The authors report on indications, surgical techniques and results obtained in 37 children up to the age of 14 (42 eyes) on whom a total of 45 keratoplasties were performed. In 5 cases keratoplasties were performed on both eyes. The grafts remained clear in 26 eyes (58%); 8 grafts were moderately opaque and 11 (24%) were completely opaque. As expected, the best results were obtained in cases of keratoconus. The keratoplasties performed in late stages of herpetic keratitis with extensive corneal scarring and vascularization were a little less successful. Of 11 eyes thus treated, a final clear graft was achieved in 8. In cases with traumatic scars after severe eye injuries, the results were less satisfactory. The prognosis is poor in all severe dystrophic alterations of the cornea, and very bleak in the final stages of central abscess or ring abscess of the cornea. In a relatively high percentage, clear grafts contrast with poor postoperative visual acuity, which may be caused by a variety of complications. The most prominent complications were amblyopia, cataracta complicata and traumatica and aphakia. Thus, only 14 out of 26 eyes with clear grafts achieved a visual acuity in the range from 0.4 to 1.0.
Pattern ERGs and pattern VECPs were recorded in 12 patients who had suffered from optic neuritis in childhood. When each individual's eyes were compared, the eye with the longer P100-latency in pattern VECP was found to have the smaller amplitude in pattern ERG. The latency differences correlated with the amplitude differences. These findings confirm that after optic neuritis the amplitude of pattern ERG is reduced.
The authors describe a 46-year-old man who suddenly developed a typical cyclic esotropia. The most unusual aspects of this case were the late onset of the condition and the unilateral high myopia associated with a severe amblyopia of the squinting eye. The 24-hour-periods of deviation were accompanied by a very disagreeable flicker in the esotropic eye. The onset of this extremely unusual disorder and rare form of esotropia usually occurs at 2 to 4 years of age. To the best of our knowledge only 2 cases of cyclic esotropia have been described in adults hitherto.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
In patients with malignant tumors in the region of the shoulder, radical resection can avoid amputation in most instances. To improve the function of the arm, endoprosthetic replacement of the defect is desirable. A three-component endoprosthesis made of a bioceramic material (aluminium oxide) was designed, implanted without bone cement. Fast anchorage to bone is achieved by using a conical sleeve, fixed upon the previously conically reamed humerus shaft. A stable primary fit is always feasible. Subsequent bone in growth into grooves inside the conical sleeve provides a permanent anchorage of the endoprosthesis. The authors experiences are based on implantations of 38 endoprostheses. The original diseases were primary malignant bone tumors in 19 patients, one case of "solitary" plasmocytoma and metastases into the proximal humerus in 16 patients. In two women, resection was made because of posttraumatic subcapital humeral pseudarthrosis. The follow-up study includes only those 27 cases operated on at least one year ago. 12 of the 14 patients with primary tumors have been surviving for 12-55 months (range 27.4) without signs of metastases or recurrent disease. Seven patients with metastases died of their original diseases after 7.7 months on the average. Owing to extensive resection of the shoulder musculature the mobility in the shoulder joint is considerably reduced. All the patients have good movement of the elbow joint and free function of the hand.
The tenotomy or tenectomy of an overactive superior oblique produces a similar effect as an elongation of the tendon. Its efficiency cannot be compared with the tenotomy or myotomy of an overactive inferior oblique or rectus muscle. No discernible underaction or complete paralysis of the superior oblique are to be feared, if the surgical indication and technique are correct. We prefer the tenotomizing of the overactive superior oblique to the recession of its insertion. Commonly, but still not always, the overaction of the superior obliques is associated with an A syndrome. Besides, the tenotomy and tenectomy of the superior oblique may be useful in true Brown's syndrome and as an additional procedure in cases of paralysis of the two elevators of one eye, During the past four years this operation was done 32 times on 24 patients. In none of these cases an insufficiency of the superior oblique was produced.