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PubMed2005

[Pay attention to recovery of the binocular vision following strabismus surgery].

The primary goal of strabismus treatment is to correct and reverse a pathologic condition. Successful treatment is associated with relief from visual confusion or diplopia, a very high incidence of sensory binocular vision, an expanded peripheral visual field, and improved psychosocial function. Binocularity before and after strabismus surgery should be well understood. The stereopsis or sensory fusion should be examined routinely. The measurements should be repeated with the angle of strabismus neutralized with loose prisms. Eye misalignment is measured using the alternate prism and cover test, Eye alignment is measured using the simultaneous prism and cover test. The recent find is that the maximum horizontal deviation that will support true stereopsis is 4(Delta). The functional benefit can usually be obtained in the form of improved binocularity and, consequently, better stability of ocular alignment.

Depth Perception↗

PubMed2005

[To exactly evaluate the treatment effect of strabismus].

To analyze the reason of the big difference of the healing rate of strabismus surgery reported in the literature in China. In the evaluation of the effect of the strabismus treatment, analyzer we should strictly master the evaluation criteria, especially the criteria for evaluating sentience state and movement. The criteria for evaluating the healing rate for the strabismus with high incidence should be refined, including consideration of the patient's satisfaction.

Humans↗

PubMedDate not supplied

[Paradoxical cortical response during the intermittent photo stimulation in the dissociated strabismus].

OBJECTIVES: To determine the behavior of the visual cerebral cortex during the photo stimulation in the dissociated strabismus. MATERIAL AND METHODS: We elaborated a digital cerebral mapping using the international 10-20 system with 21 electrodes and an option of a register of 32 channels with established parameters in every period (printed and with pulse monitoring) applied to two children with dissociated strabismus. We registered and evaluated the cortical response to different stimuli: luminous, hyperventilation, closing and opening of eyelids, asleep and awake; through digital electroencephalography, as well as the registering of ocular movements with electroculography and video film with infrared light. RESULTS: We discovered a paradoxical neuroelectrical response and the visual cerebral cortex during the intermittent photo stimulation never reported before, showing the neuroelectrical changes that occur in the dissociated horizontal deviation (DHD). We correlated these findings with the origin of the dissociated strabismus.

Brain Mapping↗

PubMedDate not supplied

Comparison of the effectiveness of mitomycin-C and Viscoat on delayed adjustable strabismus surgery in rabbits.

PURPOSE: To determine a way to prevent the formation of adhesions and delay the time of suture adjustment in the course of adjustable strabismus surgery, an animal study was performed to assess and compare the effects of mitomycin C (Mit-C) and viscoelastic material Viscoat (sodium hyaluronate 3% and chondroitin sulphate 4%, Alcon, Fort Worth, TX). METHODS: Right eyes of 47 rabbits were divided into three groups. After recession of the superior rectus muscle (SRM), Mit-C was administered beneath and over the SRM in Group M (16 eyes), Viscoat was administered beneath and over SRM in Group V (16 eyes), and ringer lactate was administered in Group C (15 eyes). SRM then recessed 5 mm with adjustable strabismus surgery technique. Animals in each group were subdivided into 1 and 2, where 1 = adjustment 1 week postoperatively and 2 = adjustment 3 weeks postoperatively. Delayed adjustment was performed in M1 group (6 eyes), V1 group (6 eyes), and C1 group (7 eyes) after 1 week; in M2 group (6 eyes), V2 group (6 eyes), and C2 group (6 eyes) after 3 weeks. Histopathologic examinations were performed for the remaining 10 eyes without suture adjustment at the end of first and third weeks after adjustable strabismus surgery. The possible length and the necessary force to adjust and the degree of adhesions were recorded. RESULTS: When length and strength of the adjustment, adhesions between muscle and sclera, and adhesions between muscle and conjunctiva were taken into consideration, there was no statistically significant difference among M, V, and C groups at postoperative weeks 1 and 3. The force needed for adjustment in M1 group was statistically lower than M2 group. CONCLUSIONS. The intraoperative use of Mit-C (0.4 mg/mL) may decrease adhesion formation in the early postoperative period, especially in the first week. The intraoperative use of Viscoat was not effective in reducing postoperative adhesions and delaying adjustment.

Animals↗

PubMed2005

[Progress in research of strabismus and amblyopia in China in the new century].

In the last 5 years, we witnessed the progress in the basic and clinical research of strabismus and amblyopia in China, which should be attributed to the effective leadership of the Chinese Ophthalmological Society and the efforts of all members of the professional team. We are glad to see the work of our researchers and clinical scientists in the studies on the molecular and neuronal mechanisms of amblyopia, visual developmental plasticity and functional brain imaging of amblyopia, in the studies on the extraocular muscle's pulley and in the studies on the diagnoses and therapies of strabismus and amblyopia, and furthermore, in epidemiological studies of strabismus and amblyopia. We expect more fruits and creative findings in this field in China in the next decade.

Amblyopia↗

PubMed2005

A small-incision muscle hook for the Parks cul-de- sac approach for strabismus surgery.

BACKGROUND: One of Dr. Marshall Parks' most valuable contributions to strabology was his cul-de-sac ("fornix") approach to strabismus surgery. This approach provides better comfort, faster healing and less conjunctival scarring than previous approaches. Tearing of the conjunctiva can occur, however, especially in older patients with thin and friable conjunctival tissues. METHODS: To facilitate the cul-de-sc approach through a small incision, especially in older patients, I designed a new "small-incision" muscle hook. RESULTS: A new sharp second bend combined with sharpening of the bend in the heel (creating literally an "S" bend) in the Jameson style eye muscle hook enables burying of the knee or heel of the hook in the wound, allowing reflection of the conjunctiva over the ball or toe of the hook without tearing. I have used and treasured this hook for over six years, routinely using the cul-de-sac approach to strabismus surgery in both children and adults. CONCLUSIONS: This new small- incision muscle hook complements the cul-de-sac approach to strabismus surgery by allowing the use of a smaller incision while significantly decreasing the risk of conjunctival tearing.

Equipment Design↗

PubMed2006

[Sevoflurane-N2O inhalation anaesthesia with laryngeal mask airway and propofol-ketamine intravenous anaesthesia in strabismus surgery].

OBJECTIVE: To investigate the advantages and disadvantages of sevoflurane-N2O inhalation anesthesia with laryngeal mask airway (LMA) and propofolketamine total intravenous anaesthesia in children undertaking strabismus surgery. METHODS: Eighty children undertaking strabismus surgery were randomly divided into sevoflurane-N2O inhalation anaesthesia group with LMA (volatile group, n=40) and propofol-ketamine total intravenous anesthesia group (TIVA group, n=40). LMA was used to secure respiratory airway in the volatile group, but LMA or endotracheal intubation was not used in the TIVA group. All children breathed spontaneously during operative period. The anesthesia was maintained with 2%-3% sevoflurane-50% N2O-50% O2 in the volatile group, and continuous intravenous infusion with propofol 5-10 mg/(kg x h) plus ketamine 1-2 mg/(kg x h) in the TIVA group. The incidence of SpO2 less than 95% and the movement of the limbs and head induced by operative stimulation, oculocardiac reflex (OCR) and postoperative vomiting (POV) were recorded in all children. RESULTS: The incidence of limbs and head movement, the incidence of SpO2 less than 95% and OCR were significantly lower in the volatile group than those in the TIVA group (P < 0.01); but the incidence of POV was significantly higher in the volatile group than that in the TIVA group (P < 0.01). CONCLUSION: Sevoflurane-N2O-O2 anesthesia with LMA can secure respiratory airway of patients, avoid hypoxemia, and have good anesthetic quality and low OCR incidence. It is a new anesthesia method with more advantages in children undertaking strabismus surgery, but the prevention and treatment of POV must be noticed.

Anesthesia, Intravenous↗

PubMed2005

The outcomes of horizontal strabismus surgery and influencing factors of the surgical success.

OBJECTIVES: To evaluate the surgical outcomes of horizontal strabismus and identify the influencing factors of the surgical success. MATERIAL AND METHOD: The medical records of 304 patients who underwent their first strabismus surgery for treatment of horizontal deviation at Siriraj Hospital were reviewed retrospectively from January 1998 to December 2003. The main outcome measure for successful surgery was defined as eye deviation 10 prism diopters or less at 6 weeks post-surgery. The outcomes of postoperative binocular function and visual acuity improvement were also evaluated. The pre operative deviation, diagnosis, binocular function, visual acuity and age were analyzed as influencing factors of surgical success. The patients were divided into two groups, the first group was 6 years or less (161 cases) and the second group was older than 6 years (143 cases). The statistical methods for analysis the data were Chi-square test, Mann-Whitney U test and Logistic regression. RESULTS: The follow- up period was from 3 to 12 months. 187 patients (61.5%) for esotropia and 117 patients (38.5%) for exotropia were identified. Mean patient's age was 10.5 +/- 10.2 years (median 6, min 0.5, max 53), mean preoperative deviation was 44.9 +/- 16.6 prism diopters and mean VA was 20/30 (no PL, 20/20). The success rate was 62.0% for esotropia and 57.0% for exotropia. There was no statistical difference between the two groups of diagnosis. The average final deviation postoperative in the success group was 6 +/- 4.9 prism diopters. The comparison of difference visual acuity between pre and post-operation showed no statistical significance but the presence of binocular vision was increased in number of patient by two times. The complication rate was 0.7% (2/304), one case showed conjunctival wound dehiscence and the other had globe perforation. Re-operative rate was 12.9% (39/304) after one year. CONCLUSION: The surgical success rate of horizontal strabismus surgery was 60.2% and revealed no statistically significant improvement of visual acuity after surgery. The successful surgery was related to the age younger than 6 years and preoperative deviation less than 30 degrees.

Adolescent↗

PubMed2006

[Dissociated horizontal deviation--a diagnostic problem in strabismus].

Dissociated horizontal deviation (DHD) is one of the four components of the dissociated strabismus complex which also includes dissociated vertical deviation, dissociated torsional deviation and manifest-latent or latent nystagmus. These dissociated deviations may co-exist with concomitant strabismus (exotropia, esotropia, hyperopia). Sometimes it is difficult to make the difference between dissociated and non-dissociated component of the deviation. We report 3 cases of strabismus and DHD with special emphasis on the diagnostic difficulties and the therapeutic possibility. A careful clinical examination with additional measurement tests makes the difference between DHD and associated tropias. The reversed fixation test is a decisive test for the diagnosis of DHD. The therapeutic approach depends on the type of DHD (uni or bilateral, latent or manifest), the magnitude of the deviation, the fixation behavior and the association of the DHD with exotropia, esotropia or orthotropia.

Adolescent↗

PubMedDate not supplied

[Strabismus-associated Parinaud syndrome].

OBJECTIVE: We undertook this study to describe the causes of Parinaud syndrome (PS) with diplopia to determine a topographic diagnosis and prognosis. METHODS: We studied patients with PS from January 1980 to January 2004 and reviewed causes and treatment. We identified all strabismus associated with PS. RESULTS: We included 18 patients with diplopia, 6 females and 12 males. Median age was 28 years old, SD 22 (10; CI 95%). Results are strabismus related: III nerve palsy in 15 patients (79%), optical nerve damage in 8 (44.4%), VII nerve palsy in 3, IV nerve palsy 2, bilateral III nerve palsy 2, nystagmus 2, Foville syndrome 2, one-and-a-half syndrome (1). The following causes were reported: tumors (6), brain stroke (4), cranial trauma (3), neurocysticercosis (2). Orthoposition under botulinum toxin treatment was obtained in 1.72 +/- 1.1 (0.65 CI 95%). Surgery was done in nine patients, and only one patient had spontaneous resolution of diplopia and PS. CONCLUSIONS: It is important to identify the topographic diagnosis and prognosis of brain diseases such as the complete study of strabismus-related PS. In this way we can learn more about the extent of damage and can identify recurrences quickly in order to offer better control.

Adolescent↗

PubMed2006

[Specifics of strabismus surgery in adults].

PURPOSE: To demonstrate that surgical approach in adult's strabismus offers not only cosmetic improvement, but also functional psychosocial benefits. MATERIAL AND METHODS: 19 eyes from 17 patients operated in Eye Clinic, Iasi, between January 2002 and June 2004, with a follow up of 12 months, were enrolled in a retrospective study. Data regarding the history of the disease (onset, cause of deviation, previous treatments), ophthalmological examination (visual acuity, binocularity, deviation), type and the results of surgical interventions were evaluated. RESULTS: Patients ranged in age from 16 to 71 years (mean 30). More than half were in the third decade. This aspect explain the option in choosing surgical treatment for two motivations: esthetic and to increase social interactions. 15 patients have strabismus since childhood and 3--associated with other ocular abnormalities. In 2 patients, the deviations installed at visual maturity as a consequence of sensorial deprivation (age related cataract, aphakia). There were 12 cases with exodeviation and 7 with esodeviations. Surgical approach consisted in resection (42.95% esodeviations, 58.33% exodeviations), recession (14.1% esodeviations, 25% exodeviations), resection-recession (42.95% esodeviations, 16.66 exodeviations). Postoperatively, we encountered successful ocular alignment in 73% cases 6 months later. We observed an increase of binocularity only in 4 patients. CONCLUSIONS: Our data proved that surgical approach in adults' strabismus have, not only cosmetic and psychosocial benefits, but also functional improvement too.

Adolescent↗

PubMed2006

Persistent diplopia and strabismus after cataract surgery under local anesthesia.

BACKGROUND AND PURPOSE: Diplopia is an infrequent complication described for retrobulbar local anesthesia. The objective of this study is to report the clinical characteristics and treatments for this surgical complication. METHODS: Retrospective study of medical records. PERIOD: 5.3 years ending February 2005. During this period, 20453 cataract surgeries were performed. The anesthesia used was retrobulbar block with ropivacaine diluted with hyaluronidase. Nineteen patients reported diplopia due to strabismus after the cataract surgical procedure and were referred for evaluation at the Extrinsic Ocular Motility Department. RESULTS: Persistent diplopia after cataract surgery occurred in 19 (0.093%) of the 20453 cases. The types of deviations found were: exotropia (n=3), esotropia (n=5), hypertropia (n=1), exotropia + hypertropia (n=5) and esotropia + hypertropia (n=5). Small deviations and dysfunction of the lateral rectus muscles were most commonly seen. Prism was applied to 4 patients, eye muscle surgery was the option in 8 patients, orthoptic treatment was performed in 3 patients and for 2 patients the decision was to only observe progress. Overall, binocular vision was restored in eleven of the nineteen patients. CONCLUSIONS: Persistent diplopia due to strabismus is an infrequent complication after cataract surgery with retrobulbar block. Etiology of this disorder of extrinsic ocular motility is variable, including mixed components. We stress the importance of adequate preoperative history of strabismus and evaluation of extrinsic ocular motility. Considering the reported incidence of this problem is as high as one in 25 cataract surgeries, one should advise the patient of the possibility of persistent postoperative diplopia and the possible need for surgical intervention and/or prism to treat the symptoms.

Adult↗

PubMed1991

Orbital cellulitis complicating strabismus surgery: a case report and review of the literature.

Orbital cellulitis is a rarely reported, but potentially vision- and life-threatening complication after strabismus surgery. To date, only seven cases of orbital cellulitis complicating strabismus surgery have been reported in the world literature, and only two cases were reported in adult patients, both occurring more than 100 years ago. We describe a case of unilateral orbital cellulitis after bilateral strabismus surgery in an adult. Early diagnosis (aided by computed tomography) and aggressive intravenous antibiotic therapy resulted in a favorable visual outcome. Diagnosis and management are discussed, and this case is compared with previous cases in the literature.

Aged↗

PubMed1991

[The prevention of postoperative vomiting following strabismus surgery in children].

Children recovering from anaesthesia for strabismus surgery are particularly prone to nausea and vomiting as a result of intraoperative vagus irritation. Besides being disturbing to the patient, vomiting can be dangerous during emergence from anesthesia and can result in delayed discharge. Droperidol is a powerful antiemetic drug that has been shown to reduce the incidence and severity of postoperative nausea and vomiting in pediatric strabismus patients, although the best timing for administration is not clear. MATERIAL AND METHODS. We compared three randomized groups totalling 61 patients. Droperidol 0.075 mg/kg i.v. was given either at induction of anesthesia after intubation (n = 20) or during the last muscle suture (n = 21). The third group received no antiemetic treatment. The patients' ages ranged from 3 to 14 years (mean 5.9 +/- 2.84 years). There was no difference in age or sex between the three groups. Anesthesia was standardized with rectal midazolam premedication, atropine, thiopental, succinylcholine, O2/N2O = 1:2, enflurane, intubation, and a gastric tube. RESULTS. Nausea, retching, or vomiting occurred in 2/20 children (10%) given droperidol preoperatively, 4/21 children (19%) with droperidol during the operation, and 9/20 children (45%) with no antiemetic treatment. The difference between groups I and III was significant (p less than 0.05). Comparison of groups II and III and groups I and II showed no statistical significance. Operation time was similar in each group and there was no delay in time of extubation. In each group 1 case of hypotension occurred. No child showed extrapyramidal symptoms. The lower incidence of vomiting in all study groups compared to the literature is thought to be due to three factors: (1) emptying the stomach at the end of the operation by a gastric tube, which is removed before extubation; (2) avoidance of opioids; (3) surgical procedure being done by a very experienced surgeon in 57/61 children (12 vomiting versus 45 not vomiting) in contrast to 3/4 children vomiting postoperatively after surgery by a less experienced surgeon. CONCLUSIONS. We recommend preoperative droperidol 75 micrograms/kg i.v. as the best prophylaxis of postoperative emesis without severe side effects in pediatric strabismus surgery.

Adolescent↗

PubMed1990

Diagnosis and management of childhood strabismus.

Strabismus is one of the most common ocular disorders encountered in children. The misalignment may be manifest in any field of gaze, may be constant or intermittent, and may occur at near or distant fixation or both. Early detection of strabismus is essential for restoration of proper alignment of the visual axes and the establishment of binocular vision. The proper assessment and management of a child with strabismus requires knowledge of the various clinical types, methods of detection and principles of treatment.

Child↗

PubMed1990

[Vertical and tortional deviations in early strabismus].

The occlusion of one eye may trigger two types of deviation: 1) Heterophorias: the occluded eye deviates towards a horizontal, vertical or torsional abnormal position of rest. Fusion keeps the eyes straight during binocular fixation. 2) Dissociated deviations, horizontal (DHD), vertical (DVD), torsional (DTD): they are found in infantile strabismus. The deviation without fixation is always smaller than the deviation of the occluded eye. The more typical cases are the ones where the position of rest without fixation is an orthoposition. Normal binocular vision is lacking. Most of the time, an alternant neutralisation is found: the occlusion deviation is not the return of the occluded eye to an abnormal position of rest. The deviation is caused by a disequilibrium of binocular retinal stimulations. Horizontal and vertical deviations are easy to study. It is not the case in dissociated torsional deviation (DTD) where the incyclotorsion does not exist when fixation is absent. An indirect proof of extorsion is given by the study of horizontal and vertical deviations determined in the cardinal position of gaze. Extorsion of the globus leeds always to abnormal actions of the recti. This give a typical synoptometer chart which is found in any extorsion whatever its origins: paralysis, alphabetic patterns or infantile strabismus. Dissociated extorsions are always associated with a bilateral elevation in the primary position. Dissociated deviations are found in infantile strabismus with the other dissociations phenomenon such as nystagmus, optokinetic nystagmus asymmetry, fixation in adduction preference (and incyclotorsion).

Accommodation, Ocular↗

PubMed1989

[Surgical treatment of torticollis in cases of congenital nystagmus with strabismus].

To correct compensatory head turn in twelve cases with congenital nystagmus, they were classified into two types according to the relative visual lines of both eyes to each other with respect to the sagittal axis of the head or the median plane of the body. One was termed the symmetrical pattern and the other was termed the asymmetrical pattern. In cases of the symmetrical pattern, a neutral zone exists in which the dominant eye in in the adducted position of gaze with esotropia and in the abducted position of gaze with exotropia. However, in the case of the asymmetrical pattern the neutral zone of the dominant eye is located in the abducted position of gaze with esotropia and in the abducted position of gaze with exotropia. Surgery was performed by shifting the dominant eye to the direction of the sagittal axis of the head in accordance with the degree of ocular deviation in the primary position. In asymmetrical pattern cares, both eyes were surgically shifted in parallel to the direction of the sagittal axis of the head without regard to the types of strabismus. The operation was based on the degree of compensatory head turn. We compared the surgical results the two types. In symmetrical cases, decreasing strabismus was disappointing compared to the head turn, while in asymmetrical cases decreasing head turn was disappointing as compared to strabismus. From these results surgery should be confined to the dominant eye in symmetrical cases, taking as the basis for operation the degree of head turn and not the ocular deviation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

Early abnormal visual experience induces strabismus in infant monkeys.

We measured ocular alignment in the horizontal direction for 17 monkeys reared under deprivation paradigms that involved monocular defocus, monocular occlusion and optically corrected aphakia coupled with continuous or partial occlusion of the fellow eye. Alignment was measured at 3 and 7 months with a photographic corneal light reflex method. Results showed that a majority of the monkeys in each paradigm developed strabismus following deprivation rearing, the common factor being early abnormal visual experience. Results also indicated a trend in which many of the deviations seen at 3 months of age were exotropic while all of the animals with deviations at 7 months of age were esotropic. These results on deprivation-induced strabismus, which are the first reported in monkeys, are consistent with previous findings in cats and humans, providing further evidence that deprivation affects not only sensory, but motor systems as well. These findings provide evidence that infant monkeys are a good model for studies of the possible relationships between amblyopia and strabismus that are often noted in children with early visual deprivation. Furthermore, it raises the prospect that some of the findings in previous animal studies that have been attributed to the direct effects of deprivation may actually be secondary to the induced misalignment.

Animals↗