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PubMed1997

[Binocular functions in amblyopia and strabismus].

Regarding the changing trends in the concept, definition, etiological classification, and criteria for diagnosis of amblyopia, we reviewed a total of 4,693 cases of amblyopia seen during the past 37 years. The amblyopia was divided into four types: strabismic, anisometropic, ametropic, and form vision deprivative. There was a definite trend for the incidence to decrease and for the diagnosis to be made during earlier age in recent years. Although favorable recovery of visual acuity is obtained after treatment of amblyopia and strabismus, there are difficulties in obtaining good binocular functions in early-onset amblyopia and strabismus. This feature was evaluated in regard to motion perception asymmetry (MPA) and binocular depth from motion (DFM). Many cases of early-onset amblyopia and strabismus showed no disparity stereopsis, or position stereopsis, in spite of the presence of DFM. The MPA appeared to be closely related to early-onset esotropia regardless of age, while it disappeared and motion perception became symmetric 4 to 5 months after birth in normal infants. The DFM seemed to play an important role in maintaining good motor alignment for several years after surgery. I developed a checkerboard pattern stimulator in 1978. This method proved to be useful in developing binocular functions and motor alignment by applying simultaneous bifoveolar stimulation and anti-suppression. Extensive exposure to the stimulation was essential for therapeutic success.

Adolescent↗

PubMed1998

[Strabismus surgery in adults].

The authors operated 24 adult patients with strabismus (20 with concomitant, 4 with paralytic) aged 18 to 66 years, mean age 30.5 years. They focused attention on the possibility to adjust the deviation, to achieve binocular vision and postoperative diplopia. Based on their own results and those of other authors they found that surgery of strabismus in adults is not only a cosmetic operation. The possibilities to adjust the deviation are very favourable, and this applies also to achievement of binocular vision. The latter was attained in 66.7% of the patients. Postoperative diplopia in patients, incl. those with abnormal retinal correspondence, is only a rare complication. The authors recommend that adult patients with strabismus demanding operation should not be refused.

Adolescent↗

PubMed1998

Outcome criteria in strabismus surgery.

Criteria for success in strabismus surgery should include more than just the alignment result in primary position. It is important to consider as well the extent of the field of BSV gained: restoring a useful range of BSV will maximize the patient's ability to carry on daily activities. Psychometric tests can also be used to provide objective measures of improvement following strabismus surgery. Irrespective of the patient's age, the realigning of an eye is reconstructive, not cosmetic, surgery. Surgery in children and adults can restore fusion and normalize the field of BSV in most cases. These gains are possible even in the presence of amblyopia. It could be argued that realigning a blind eye yields no functional improvement and should not necessarily be covered by insurance plans. These cases are not common. In all other cases the functional benefits of adult strabismus surgery justify maintaining insurance coverage for this surgery in jurisdictions throughout North America.

Adult↗

PubMed1998

Effect of BL-10 (tianzhu), BL-11 (dazhu) and GB-34 (yanglinquan) acuplaster for prevention of vomiting after strabismus surgery in children.

BACKGROUND: Stimulation of P6 (Neiguan) acupoint can prevent nausea and vomiting in adults. However, there is no antiemetic effect in children undergoing strabismus surgery. The effect of P6 may act only on hollow organs; in contrast, BL-10 (Tianzhu), BL-11 (Dazhu) and GB-34 (Yanglinquan) are more related to the meridians of the eye. Therefore these three more relevant acupoints, BL-10, BL-11 and GB-34 were stimulated to evaluate the antiemetic effect in children undergoing strabismus surgery. METHODS: Sixty-five children, ASA physical status I, between 3 and 14 years of age, were randomly divided into two groups as follows: placebo group (n = 31) and acuplaster group (n = 34). Bilateral acupressure using the Vital Point Needleless Acuplaster (Koa, Japan) was applied to BL-10, BL-11 and GB-34 points the night before surgery. Anesthesia was induced and maintained with halothane and nitrous oxide in oxygen. Postoperative emesis was assessed at early (at PACU) and late (at ward) phases, and was recorded by an investigator blind to the treatment characteristics. RESULTS: In the early emesis phase, the incidence of vomiting was 35.5% for placebo group, compared with 14.7% for acuplaster group. In the late emesis phase, acuplaster patients had a significantly lower incidence of vomiting (23.5% vs. 58.1% in placebo patients, p < 0.05). The overall postoperative vomiting incidence in the acuplaster patients in a 24 h period which was significantly decreased was 29.4% as opposed 64.5% in the placebo group (p < 0.05). CONCLUSIONS: The results demonstrated that prophylactic use of bilateral noninvasive acuplaster on the BL-10, BL-11, and GB-34 acupoints significantly reduces vomiting after strabismus correction. The mechanism may be dispersal of these three acupoints, thus diminishing the parasympathetic stimulation resulting from surgical traction of eye muscles.

Acupressure↗

PubMedDate not supplied

Postoperative analgesia in children using preemptive retrobulbar block and local anesthetic infiltration in strabismus surgery.

BACKGROUND AND OBJECTIVES: Postoperative pain management in pediatric strabismus patients is infrequently studied. Pediatric patients can be mobilized earlier if postoperative pain is minimized. In this study, two different regional anesthetic techniques, retrobulbar block and local infiltration, were compared with a "no block" control group for the postoperative management of pain in pediatric patients undergoing elective strabismus surgery. METHODS: Thirty patients were randomly allocated to one of the study groups: group 1 (n=10) control, group 2 (n=10) retrobulbar block, and group 3 (n=10) subconjunctival bupivacaine infiltration. The parameters that were evaluated during the early postoperative period (6 hours) were circulatory, pain scores by Visual Analog Scale (VAS) and Modified Pediatric Objective Pain Scale (MPOPS), additional analgesic requirement, nausea, and vomiting. The parameters that were evaluated after discharge from the hospital (on postoperative days 1 and 2) through questionnaires were additional analgesic requirement, nausea, vomiting, sleep disturbances, activity, and appetite. RESULTS: Group 3 had significantly higher VAS and MPOPS scores at postoperative 120, 180, 240, 300, and 360 minutes than groups 1 and 2 (P < .05). Patients in group 2 seemed to have a higher incidence of nausea and vomiting both in the early (6 hours) and late postoperative (postoperative days 1 and 2) periods; however, the difference was not statistically significant. Group 2 required less analgesic compared with groups 1 and 3 during the late postoperative period. Late postoperative activity and appetite were better in groups 2 and 3. CONCLUSIONS: Because there was no significant difference in terms of postoperative analgesia in the retrobulbar block or subconjunctival local anesthetic infiltration groups compared with the control group, we suggest that conventional methods of pain treatment are adequate for postoperative analgesia in strabismus surgery.

Activities of Daily Living↗

PubMed1998

[Adjustable sutures in various types of strabismus operations: surgical techniques].

The paper presents the operations of strabismus conducted with the use of adjustable sutures. The surgical technique, together with modifications, and the criteria applied to patients' surgical qualification have been described. The adjustable suture technique allows for fine tuning of ocular alignment in the immediate postoperative period while the patients is free of the effects of anesthesia. The most important indication for an adjustable suture is complicated reoperations, including paralytic strabismus, large--angle strabismus, reoperations, and thyroid myopathy. In these situations, the standard tables for surgical measurements do not apply, and results with the fixed--suture technique are unpredictable.

Humans↗

PubMed2006

Strabismus surgery for elimination of bifocals in accommodative esotropia.

PURPOSE: This study reports the outcomes of strabismus surgery to eliminate bifocals in patients with accommodative esotropia with a high accommodative convergence to accommodation (AC:A) ratio. DESIGN: Retrospective interventional case series. METHODS: Sixteen patients who wore bifocals for treatment of accommodative esotropia with a high AC:A ratio underwent strabismus surgery following prism adaptation testing (PAT) for the near angle of esotropia without bifocals. Outcomes were considered successful if patients had microtropias and maintained fusion without bifocals. RESULTS: All patients had successful outcomes after one or two surgeries. Three of 13 (23%) patients with positive PATs required two surgeries. Two of three (67%) patients with negative PATs required two surgeries. Binocularity remained the same in 13 patients and improved in three patients. Glasses were eliminated entirely in eight of 16 (50%) patients. CONCLUSIONS: Strabismus surgery may eliminate the need for bifocal glasses in patients with accommodative esotropia with a high AC:A ratio, with many patients able to discontinue glasses entirely. Preoperative PAT may help predict the risk of requiring more than one surgery.

Accommodation, Ocular↗

PubMed2003

Myopic strabismus fixus: a mitochondrial myopathy?

PURPOSE: Ultrastructural analysis of extraocular muscle in a case of myopic strabismus fixus. DESIGN: Interventional case report. METHODS: Incisional biopsy and ultrastuctural analysis of recti muscles in a female patient with myopic strabismus fixus. RESULTS: Ultrastuctural analysis revealed evidence of mitochondrial myopathy. CONCLUSION: Acquired strabismus fixus due to high myopia may be a manifestation of mitochondrial myopathy, a finding that has not been previously reported.

Adult↗

PubMedDate not supplied

Predictors of postoperative binocularity in adult strabismus.

We evaluated postoperative binocularity in a retrospective study of 111 adult strabismus patients in order to identify the factors which influence the success of surgery for horizontal concomitant strabismus in adults. Selection criteria included minimum age of 15 years at time of surgery, and preoperative fusion impairment with both the Bagolini lens test and synoptophore. Logistic regression analysis was used to correlate patient factors and postoperative binocularity. We found that 52 (65%) of 80 patients with exotropia and 23 (74.2%) of 31 patients with esotropia achieved post operative fusion. Significant predictive factors in exotropia were absence of previous surgery; visual acuity of the deviating eye > 0.5; an increase in the spherical equivalent of the deviating eye, and normal retinal correspondence. Significant predictive factors in esotropia were fusion during prism adaptation, absence of infantile esotropia, and an increase in vertical deviation. The majority of adults with exotropia or esotropia can achieve binocularity after surgery for horizontal concomitant strabismus.

Adolescent↗

PubMed2006

Propofol-remifentanil-based anaesthesia vs. sevoflurane-fentanyl-based anaesthesia for immediate postoperative ophthalmic evaluation following strabismus surgery.

BACKGROUND AND OBJECTIVE: Following strabismus surgery, immediate postoperative ophthalmic evaluation may be desired. Thus, an anaesthetic technique allowing rapid recovery of ocular motility is required. Saccadic eye movements is a biophysical monitor of ocular motility and may be used to assess recovery from anaesthesia. The aim of this study is to compare the time to the recovery of saccadic eye movements in patients, following one of two anaesthetic techniques: Propofol-remifentanil-based anaesthesia vs. sevoflurane-fentanyl-based anaesthesia. METHODS: Fifty adult patients undergoing strabismus surgery were randomly assigned to one of two groups: patients in Group R received induction and maintenance of anaesthesia with propofol and remifentanil, while patients in Group S received induction of anaesthesia with propofol and fentanyl and maintenance of anaesthesia with sevoflurane. Recovery from anaesthesia was measured from the time all anaesthetics were turned off and was assessed every 2 min. Recovery time was attained when patients were able to generate brisk saccadic eye movements. At recovery time, the ophthalmic evaluation was started. RESULTS: The mean recovery time of saccadic eye movements was significantly shorter in the Group R when compared to the Group S (12.1 +/- 4.3 min vs. 21.5 +/- 4.7 min, respectively, P < 0.0001). More patients in Group S experienced nausea and vomiting postoperatively as compared to Group R (9/25 vs. 2/25, respectively, P = 0.037). CONCLUSIONS: Propofol-remifentanil-based anaesthesia may be a useful technique in strabismus surgery when immediate postoperative ophthalmic evaluation is desired. When compared to sevoflurane maintenance of anaesthesia, it allows for a more rapid recovery from anaesthesia as judged by recovery of saccadic eye movements and a decreased incidence of postoperative nausea and vomiting.

Adolescent↗

PubMed1999

Convergent strabismus in a white Bengal tiger.

A white Bengal tiger was noted to have a convergent strabismus with poor vision since a cub. The tiger and a littermate with normal colouring and apparently normal eyes were anaesthetised for comparative ocular examination. A fundus typical of colour-dilute cats and dogs was noted in the white tiger. Except for strabismus, no abnormalities were observed. Electroretinography showed similar retinal function in both tigers. Possible causes of strabismus considered were an adaptation to genetically determined abnormal visual pathways related to lack of pigment, abnormalities of the abducent nerves and mechanical restricting conditions of the medial rectus muscles.

Animals↗

PubMedDate not supplied

Suprachoroidal septic effusion leading to panophthalmitis following strabismus surgery.

We describe a case of endophthalmitis following strabismus surgery. Drainage of the suprachoroidal effusion with injection of antibiotics was unsuccessful in salvaging vision. Endophthalmitis following strabismus surgery may present with findings simulating a choroidal effusion or hemorrhage. Treating physicians should be alert to signs and symptoms of this severe complication of strabismus surgery in preverbal children.

Anti-Bacterial Agents↗

PubMed1999

Metabolic mapping of suppression scotomas in striate cortex of macaques with experimental strabismus.

Misalignment of the ocular axes induces double vision and rivalry. To prevent these unpleasant sensations, most subjects fixate preferentially with one eye and suppress entirely the deviating eye or else suppress portions of the visual field of either eye. To explore the mechanism of visual suppression, a divergent strabismus (exotropia) was induced in six normal, adult Macaca fascicularis by disinserting the medial rectus muscles. After 4-8 weeks, each animal was chaired to measure its exotropia and to determine its ocular fixation preference. Five of the monkeys developed a clearly dominant eye. It was injected with [(3)H]proline. Alternate sections from flat-mounts of striate cortex were then processed either for autoradiography to label the ocular dominance columns or for cytochrome oxidase (CO) to assess local metabolic activity. Two CO patterns were seen, often in the same cortex. The first consisted of thin dark columns alternating with wide pale columns. This pattern arose from reduced CO activity in the suppressed eye's monocular core zones and both eyes' binocular border strips. The second pattern consisted of thin pale bands from reduced metabolic activity in both eyes' border strips. The thin dark-wide pale CO pattern was more widespread in the three animals with a strong fixation preference. The dark CO columns usually fit in register with the ocular dominance columns of the fixating eye, suggesting that perception was suppressed in the deviating eye. In most animals, however, the correlation switched in peripheral cortex contralateral to the deviating eye, implying local suppression of the fixating eye's temporal retina (beyond 10 degrees), as reported in humans with divergent strabismus. In the two animals with a weak fixation preference, pale border strips were found within the central visual field representation in both hemispheres. This CO pattern was consistent with alternating visual suppression. These experiments provide the first anatomical evidence for changes in cortical metabolism that can be correlated with suppression scotomas in subjects with strabismus.

Animals↗

PubMed2000

Motion VEPs, stereopsis, and bifoveal fusion in children with strabismus.

PURPOSE: The link between nasal-temporal motion asymmetries and anomalous binocular sensory function in infantile esotropia (ET) has led to the idea that visual evoked potential responses to horizontal motion (mVE) is an alternative measure of sensory binocularity to stereopsis. A second hypothesis is that the mVEP response is a marker for bifoveal fusion. The purpose of this study was to directly evaluate these two hypotheses by examining the correspondence between the mVEP response and both stereoacuity and bifoveal fusion in a cohort of strabismic patients with variable binocular sensory function. METHODS: Motion VEPs, random dot stereopsis, and bifoveal fusion were measured in 94 children: 20 with infantile ET, 16 with infantile accommodative ET, 22 with late-onset accommodative ET, 10 with intermittent infantile strabismus, and 26 normal control participants. RESULTS: Patients with infantile ET and infantile accommodative ET had high concordance between mVEP responses and stereoacuity and mVEP responses and bifoveal fusion. Asymmetric mVEP responses were highly concordant with both no measurable stereopsis and an absence of fusional vergence. Patients with late-onset accommodative ET and intermittent infantile strabismus revealed discordance between the mVEP response and stereoacuity and high concordance between the mVEP response and bifoveal fusion. Asymmetric mVEP responses were highly concordant with the absence of bifoveal fusion and the minimum-size prism to elicit fusional vergence. CONCLUSIONS: The qualitative and quantitative relationship between the mVEP response and fusional vergence suggests that the mVEP response is an objective measure of bifoveal fusion. The availability of such a test will facilitate studies of normal development of bifoveal fusion and development of monofixation syndrome in strabismus.

Accommodation, Ocular↗

PubMed2001

[The Faden operation in strabismus surgery].

PURPOSE: Is to evaluate the indications of Faden operation and the postoperative results. MATERIAL AND METHOD: We studied a number of 32 patients with convergent strabismus operated in the Universitary Eye Hospital from Cluj, during 1998-2000 at whom we performed Faden operation with conventional surgery on the medial rectus. The anAestesia was with ketamine i.v. RESULTS: The majority of patients where females (62.50%) with ages between 0-14 years. We performed surgery in cases of convergent strabismus with spasm of fixation. The postoperative results were promising; in 23 cases we obtained ortHophory, in 8 cases a remaining deviation angle (5-10 D P), and in 1 case a deviation angle above 5-10 D P. CONCLUSIONS: 1. Faden operations is indicated to correct the spatical component of the deviation angle. 2. The postoperative good results are depending on the aSsociations of Faden operation with conventional surgery. 3. Under or above correction of the strabismus is linked with a deficiency of the conventional surgery associated.

Adolescent↗

PubMed2002

Structure and expression of Strabismus 1 gene on human chromosome 1q21-q23.

Xenopus Strabismus (Stbm) is a negative regulator of the WNT - beta-catenin signaling pathway. Strabismus 1 (STB1/VangL2) and Strabismus 2 (STB2/Vangl1) are human homologues of Xenopus Stbm and Drosophila Stbm/ Van Gogh (Vang) STB1 and STB2 are four-transmembrane-type proteins with Dishevelled-binding motif. STB2 and CASQ2 genes are located on human chromosome 1p13.3-p11 with an interval less than 5 kb. Here, STB1 gene and CASQ1 gene were found to be located on human chromosome 1q21-q23 with an interval of about 210 kb including Nicastrin, COPA, PXF, H326 and PEA15 genes. Exon-intron structure was well conserved between STB1 and STB2 genes. STB1-CASQ1 gene cluster and STB2-CASQ2 gene cluster might be generated due to duplication of ancestral gene cluster, and several genes might be inserted into the STB1-CASQ1 intergenic region during or after gene-cluster duplication. STB1 mRNA was relatively highly expressed in prostate, trachea, thymus, lymph node, placenta, fetal kidney, fetal brain, and fetal lung. In adult brain, STB1 mRNA was more highly expressed in cerebellum, corpus callosum, amygdala, and medulla oblongata. STB1 mRNA was moderately expressed in K-562 (chronic myelogenous leukemia), G-361 (melanoma), and MKN7 (gastric cancer). On the other hand, STB1 mRNA was almost undetectable in several human cancer cell lines, and was down-regulated in 4 out of 14 cases of primary kidney tumors, and in 2 out of 3 cases of primary lung cancer. Loss-of-function mutation of STB1 gene might lead to carcinogenesis through activation of the WNT - beta-catenin signaling pathway.

Amino Acid Sequence↗

PubMed2004

A case of a slipped medial rectus muscle after strabismus surgery.

BACKGROUND: A slipped muscle after strabismus surgery is a well known complication, but only a few cases have been reported in the medical literature. Here, we report a case of a slipped medial rectus muscle that occurred after strabismus surgery for esotropia. CASE REPORT: The patient was a 10 year old male with an acquired esotropia of 20 PD at distance. For treatment, 3.5 mm bilateral medial rectus recessions was performed. There were no complications during the procedure. On postoperative day 8, the eye position was orthotropic in primary position, but a right exotropia was observed in left gaze. The boy was frequently observed rubbing his right eye after surgery. The right exotropia increased to 30 PD 2 months after surgery. Limited adduction of the right eye, a large widening of the lid fissure on adduction, and mild exophthalmos were observed. Based on the above findings, a slipped medial rectus was suspected, and a second surgery, advancement of the right medial rectus muscle was performed 2.5 months after the initial procedure. After this second procedure, the eyes became orthotropic, and the adduction disorder, large widening the lid fissure, and mild exophthalmos resolved. CONCLUSION: The slipped muscle may have been caused by insufficient suture and/or excessive rubbing of the eye by the patient. When divergent strabismus is observed after recession of the medial rectus muscle, a slipped muscle should be considered as a differential diagnosis.

Child↗

PubMed2005

[Interhemispheric connections in the visual cortex of cats reared with bilateral strabismus].

We have determined the spatial distribution of retrograde labelled callosal cells after microiontophoretic horseradish peroxidase injections into the single cortical columns of area 17, 18 in cats reared with bilateral convergent strabismus. The obtained strabismus angle was in the range 10-35 degrees. The zone of labelled cells was located asymmetrically in respect to location of injected column in opposite hemisphere. Some cells were revealed in the transition zone 17/18 and their retinotopic coordinates corresponded to the injected column, as was shown in intact cats. Other labelled cells were located in areas 17, 18, in clusters approximately in 1000 mkm from marginal clusters of transition zone. Analysis of labeling in lateral geniculate nucleus has shown that most of the injected columns were driven by ipsilateral eye. The data obtained may be interpreted as evidence of eye-specificity of monosynaptic callosal connections. The functional role in such connections changes in cats with bilateral strabismus is discussed.

Animals↗