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PubMed1994

[Vertical deviation in strabismus in children].

Cyclovertical deviations represent a major diagnostic and therapeutic problem in strabology. In this paper 4 topics are discussed. Long term evolution of strabismus after surgery shows that the patient's residual threshold for a residual vertical factor is very weak; its correction is of the utmost importance. Indeed, if some degree of binocular vision is to be recovered, the residual vertical factor should not be greater than 4 D in esotropia. There are many different varieties of vertical deviation but 3 are particularly common: oblique muscles overactions, DVD and alphabetical syndromes. There are several arguments against sagittalization during oblique muscles development. The author then presents an epidemiological survey of vertical factors based on a randomized study of 1500 consecutive cases of strabismus. In the last section, the problem of vertical factors in accommodative strabismus is discussed; there are many arguments against Gobin and Berard's ideas on the role and management of optical correction in accommodative squint.

Accommodation, Ocular↗

PubMedDate not supplied

[Surgical treatment of paralytic convergent strabismus using a modification of Jensen's method].

Surgical treatment of paralytic convergent strabismus using the modified Jensen's is method was performed in 35 patients. The full success (orthophoria) was achieved in 51.5% and satisfying (approximately orthophoria) in 25.7% of cases. The six-year follow up of patients showed that surgical effect was permanent in 71.4% of cases. The most common cause of paralytic convergent strabismus has been trauma (71.4%), and, that, traffic accidents in 45.7%. According to communications and available literature this modified treatment of paralytic convergent strabismus for the first time in Yugoslavia has been applied in the Military Medical Academy.

Adolescent↗

PubMed1993

Combined cataract and strabismus surgery.

A patient with cataracts and congenital exotropia underwent combined cataract and strabismus surgery OU. A lateral rectus recession plus an extracapsular cataract extraction with intraocular lens implantation was done OD first; three months later, this procedure was repeated OS. The patient's postoperative course was benign in both cases, and her strabismus resolved after the second operation. A combined surgical approach to cataracts and strabismus (where only a single muscle is involved) was safe and useful in restoring this patient's vision, binocularity, and appearance.

Aged↗

PubMed2000

Use of apically based periosteal flaps as globe tethers in severe paretic strabismus.

OBJECTIVE: To evaluate the technique of using an intact autogenous periosteal flap for tethering of the globe in patients with severe paretic strabismus. METHODS: We performed a periosteal flap procedure on 5 patients and followed their postoperative course. The flap was created from the medial, lateral, or superior orbital walls. A description of the harvesting and manipulation of the flap and the initial postoperative findings are presented. RESULTS: All patients showed marked reduction in their postoperative strabismic deviation compared with preoperative measurements. Greater early postoperative swelling was noted after this procedure than with the standard strabismus surgery. No complications were experienced during or after surgery. Two patients required a second operation for adjustment of the periosteal flap for adequate alignment. CONCLUSIONS: The vascularized periosteal flap technique provides an excellent tether for the globe. Early and late stability has been favorable.

Aged↗

PubMed2001

Ripcord adjustable suture technique for use in strabismus surgery.

Adjustable sutures in strabismus surgery may be difficult or impossible in poorly cooperative patients. An adjunct suture technique that allows a 1-step, all-or-nothing, preprogrammed adjustment in patients not considered good candidates for standard postoperative adjustable sutures is described. Twelve patients underwent adjustable strabismus surgery using the ripcord technique. Six patients had unacceptable alignment after surgery. In 5 of these, alignment was successfully adjusted. The ripcord adjustable suture technique is effective and is well tolerated by patients.

Adolescent↗

PubMed1978

Fluorescein iris angiography. II. Disturbances in iris circulation following strabismus operation on the various recti.

Iris circulation was investigated by fluorescein iris angiography in 33 human eyes before and after tenotomy of one or more recti for correction of strabismus. Tenotomy of one or both horizontal recti produced no appreciable circulatory disturbance in the iris, but tenotomy of superior or inferior rectus produced circulatory delay in superior temporal or inferior temporal sectors, respectively, of the iris. When tenotomies of a horizontal and one or two vertical recti were combined, the defect occurred in the region of the vertical rectus only. Blood supply of the nasal half of the iris was usually not disturbed by tenotomy of the vertical and/or medial rectus. The findings indicate that the blood supply of the iris is segmental and suggest that, in strabismus surgery, cutting the two vertical recti along with the lateral rectus may subject the eye to the risk of anterior segment ischemia. In the light of the present findings, physiological anatomy of the blood supply of the iris and role of the major arterial circle of the iris are discussed.

Adolescent↗

PubMed1980

Structural features of extraocular muscles of children with strabismus.

Ninety extraocular muscle (EOM) biopsy specimens from 80 children with strabismus and normal ocular alignment were studied by light microscopy, enzyme histochemistry, and electron microscopy. Light microscopy showed considerable variation in muscle fiber shape and size with sarcomere disruption, sharp increases in endomysial and perimysial collagen, numerous vacuoles and subsarcolemmal inclusions. Electron microscopy showed disruption of myofilaments, nemaline rods, abnormal mitochondria, leptomeric profiles, occasional "myelin figures," glycogen, and lipid-like droplets. Some intramuscular nerves contained long-spacing collagen ("Luse bodies"). Unlike somatic skeletal muscle, EOM showed a consistent lack of mosaic pattern and reciprocal stain activity between fiber types noted by enzyme histochemistry. Quantitative observations indicate that minimal but consistent morphologic differences exist between strabismic and nonstrabismic EOM. The role these changes play in the pathogenesis of strabismus and their significance remains unclear.

Adenosine Triphosphatases↗

PubMed1980

Astigmatism in visually immature child with strabismus.

Astigmatic refractive errors may develop late in the visual maturity period of strabismic children. Seventeen strabismic children who had surgery and ten strabismic children who did not have surgery are discussed; none had astigmatic error at the initial refraction. Significant astigmatism developed in both groups at age 4 years and two years after the initial refraction. The ophthalmologist should be aware that late-developing astigmatism can cause a recurrence or deterioration of strabismus. The best response is serial refractions and appropriate correction of all strabismus patients during the visual maturity period.

Aging↗

PubMed1982

Strabismus and amblyopia associated with regressed retinopathy of prematurity.

A series of 38 patients with regressed retinopathy of prematurity were compared with control groups of babies having similar gestational age who did not have retinopathy of prematurity, and to a control group of full-term babies. A substantially higher incidence of strabismus, amblyopia, and high refractive errors was found in the group with retinopathy of prematurity as compared with both other groups. In general, these patients had a successful response to standard amblyopia and strabismus management. No substantial difference was found between the refractive errors of the babies in the premature control group and the term control group.

Amblyopia↗

PubMed1983

Suppression in strabismus and the hemiretinal trigger mechanism.

A perimeter and a modified Lees screen were used to determine the area of visual field that is suppressed in strabismus. Strabismic patients without fusion suppress the whole area of the visual field of the deviating eye that could have correspondence with the dominant eye. In the monofixation syndrome, suppression only involves the fovea and the diplopic point of the deviating eye. Diplopia, if present, is appreciated throughout the visual field shared by the two eyes, except for the blind spots. No evidence of hemiretinal suppression was found in any type of horizontal strabismus, including exotropia. However, there is a hemiretinal trigger mechanism for suppression. Once suppression has been triggered by this mechanism, it involves the whole visual field of the deviating eye, except for the monocular temporal crescent.

Adolescent↗

PubMed1987

Adjustment sensitivity of horizontal rectus muscles in adjustable strabismus surgery.

A "marking suture" was used in 12 consecutive cases of adjustable strabismus surgery to determine the relationship between ocular alignment and the amount of horizontal muscle adjustment. The average change in ocular alignment was 2.55 prism diopters for each millimeter of muscle adjustment. Regression analysis revealed the relationship to be linear over the range of adjustments studied. The sensitivity of adjustment was the same whether the adjusted muscle was advanced or further recessed and whether the adjusted muscle was the medial rectus or the lateral rectus. No relationship was found between the distance of a recessed muscle from its normal insertion and the subsequent adjustment sensitivity of that muscle. This information, when used clinically in conjunction with a marking suture, can facilitate the adjustment phase of adjustable strabismus surgery.

Adolescent↗

PubMed1993

Strabismus following implantation of Baerveldt drainage devices.

OBJECTIVE: To describe the clinical features of strabismus following implantation of a Baerveldt glaucoma seton. DESIGN: Case series of four patients with a minimum follow-up of 6 months. SETTING: Specialized glaucoma referral center at Bascom Palmer Eye Institute/Ann Bates Leach Eye Hospital, Miami, Fla. PATIENTS: Consecutive sample of four patients with persistent binocular diplopia following implantation of a 350-mm2 Baerveldt glaucoma seton in the superotemporal quadrant. RESULTS: Each patient presented with a characteristic pattern of either exotropia or hypertropia, or both. The deviation increased with gaze opposite the ipsilateral superior and lateral muscles and decreased in the field of action of the involved muscles. All patients demonstrated a convergence insufficiency type of exotropia. CONCLUSION: These patients presented with a similar type of restrictive strabismus. Proposed mechanisms include an increase in the length-tension curve of the muscle induced by the underlying bleb and a posterior fixation effect as a result of scarring behind the implant.

Aged↗

PubMed1987

Occurrence of strabismus in infants born to drug-dependent women.

Maternal drug abuse during pregnancy exposes the fetus to the possibility of toxic or addicting effects. At a methadone hydrochloride maintenance program providing medical care to drug-dependent women and their infants, ophthalmologic examinations of all infants born during a 36-month period were performed. Twenty-nine infants prenatally exposed to psychoactive drugs were seen at birth and on follow-up. The 24% prevalence of strabismus found in the drug-exposed infants was significantly greater than that of 2.8% to 5.3% reported in the general population. These data suggest that maternal drug abuse and increased methadone dosage during pregnancy may predispose infants to the development of strabismus.

Female↗

PubMed1976

Sensorial anomalies in strabismus. (suppression, anomalous correspondence, amblyopia).

Some concepts regarding suppression, anomalous correspondence and amblyopia are revised according to the sensorial findings obtainable from esotropic patients directly in casual seeing (with the aid of the striated glasses test) and by grading a sensorial dissociating effect (with the aid of a bar of optical filters). The following points are emphasized: 1. Suppression appears to be minimal in small angle strabismus where diplopia seems mainly to be avoided by an anomalous correspondence mechanism. On the contrary, suppression is the prevalent mechanism in large angle strabismus. 2. The anomalous correspondence mechanism may lead to a weak type of anomalous binocular vision which is easily interrupted by light optical filters or by dissociating tests. 3. The subjective space of patients with anomalous binocular vision resembles that of normal binocular vision in some aspects. 4. The development of amblyopia is interpreted in the light of these new concepts on suppression and anomalous binocular vision. 5. Postoperatively, anomalous correspondence rapidly re-adapts to the smaller angle deviation and may normalize if the deviation is completely eliminated. This is evident only in casual seeing; for a certain time, dissociating tests reveal the preoperative correspondence status. This behaviour of correspondence in casual seeing has led to attempts at normalizing anomalous correspondence by prism therapy. Newly observed sensotio-motorial obstacles, however, have been found to frequently hamper treatment in casual seeing.

Amblyopia↗

PubMedDate not supplied

The length-tension diagrams of human oblique muscles in trochlear palsy and strabismus sursoadductorius.

We determined the relation between length and tension in detached oblique muscles of 16 strabismus patients that underwent surgery, before and during contraction evoked by intravenous administration of succinylcholine. We frequently found a nonlinear relation between length and tension, unlike our previous findings in recti. In superior oblique palsies, the superior oblique was found, before injection of succinylcholine, to be stiff after elongation, and did not contract after injection of succinylcholine, while the ipsilateral inferior oblique contract after injection of succinylcholine, but with a higher spring constant than did usual. In 3 cases the superior oblique contracted vividly after administration of succinylcholine despite the presence of excyclotropia, stereopsis, torticollis (2 cases) and a hypertropia that increased in adduction, in downgaze, in adduction-and-downgaze and on ipsilateral head-tilt. The finding of a vividly contracting superior oblique is incompatible with the diagnosis of a complete superior oblique palsy. We conclude that some of the cases diagnosed as congenital superior oblique palsy, having a hypertropia increasing in adduction, in downgaze, in adduction-and-downgaze and on ipsilateral head-tilt, are in fact cases of unilateral strabismus sursoadductorius (upshoot in adduction), a non-paretic motility disorder.

Adolescent↗

PubMed1983

Binocularity in comitant strabismus: II. Objective evaluation with visual evoked responses.

Campos (1982a) reported on his psychophysical studies on the binocularity of patients with comitant strabismus. With binocular visual field techniques, it was possible to show that patients with small-angle eso- and exotropia exhibit a binocular vision, without suppression of the deviated eye. In the present paper visual electrophysiology is used objectively these findings and to provide more insight in the problem. First, the studies on binocularity in normals and strabismics, done by using visual evoked responses (VER) are reviewed. This type of investigation is relatively new and the results of the literature are still conflicting. Then personal results of the authors are reported. It is shown that with VER it is possible to objectively assess the presence of anomalous binocular vision (ABV) sustained by anomalous retinal correspondence (ARC) in small-angle strabismus. In patients with large angle deviations this type of binocularity is absent. A correlation between psychophysical and electrophysiological data is provided. Lastly a simple method is described for differentiating the binocularity of normals from that of Strabismics with ARC. This method is based on the recording of binocular VER with the anteposition in front of the fixing eye of neutral filters of increasing density.

Adolescent↗

PubMed1978

Zero retinal image disparity: a stimulus for suppression in small angle strabismus.

Suppression was examined with binocular perimetry in patients with small angle strabismus. Suppression stimuli were presented to the fovea of the fixating eye or 5 degrees nasal or temporal from the fovea. Suppression was found in the deviating eye of patients with normal or anomalous correspondence at retinal points corresponding to the retinal locus of the suppression stimulus. Suppression was demonstrated on both the nasal and temporal hemiretina of the deviating eye. Results indicate that zero retinal disparity is a strong stimulus for suppression in the central and peripheral visual field of patients with small angle strabismus.

Adolescent↗

PubMed1981

Effects of strabismus on development of cortico-geniculate projections in the kitten.

In six kittens reared with surgically induced strabismus, three each of convergent and divergent types, we studied 208 striate cortex cells. Of these, 22 were identified as projecting to the dorsal lateral geniculate nucleus (LGN) on the basis of antidromic activation from LGN and of histological localization within cortical layer VI. We classified these cortico-geniculate cells according to their axonal conduction velocities which in normal cats, are generally grouped into slow, intermediate, or fast categories. Proportions and mean conduction velocities of slow and fast groups were approximately the same as in the normal cat, but the intermediate group was almost entirely missing with only one cell classified as such. Our results suggest that development of the intermediate group, which has previously been implicated in functional binocular vision, may be impaired selectively by strabismus.

Aging↗