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PubMedDate not supplied

Localized conjunctival argyrosis: a late sequela of strabismus surgery.

We describe a case of focal argyrosis of the conjunctiva clinically simulating a melanoma. An 82-year-old woman was referred for an asymptomatic pigmented conjunctival lesion. Her only significant past ocular history was strabismus surgery 76 years earlier. Biopsy of the conjunctiva and lateral rectus muscle revealed the discoloration was pigment granules. Energy-dispersive x-ray microanalysis revealed the pigmentation to be silver deposits. The patient had strabismus surgery probably using a silver clip. Argyrosis should be considered in the differential diagnosis of focal pigmented conjunctival lesions.

Aged↗

PubMed2001

[ADAL-1(R): a new synthetic adhesive for use in strabismus surgery].

PURPOSE: To evaluate the efficacy and tolerance of ADAL-1(R), a new adhesive in strabismus surgery. METHODS: Three groups of 10 eyes each of 30 albino rabbits underwent superior rectus muscle recession 4 mm, 1(st) group of 10 eyes using the new adhesive, sacrified after one week, 2(nd) group of 10 eyes also with ADAL-1(R), sacrificed after one month and the 3(rd) group (control) of 10 eyes using Dexon 6/0 suture, sacrificed after one month. Clinical evaluation was done at the 1(st) postoperative day, at one week and at one month. The presence of residue of the adhesive, its hardness and the condition of the muscle were all studied after sacrificing the animal. Descriptive study was done for the 1(st) and the 2(nd) group, within the 2(nd) group significant changes along the follow up period were studied using the Friedman test and also differences between the 2(nd) and the suture group were examined using the Fisher's Exact Test. RESULTS: The inflammatory reaction was evaluated between absent and mild in 80% of the cases, both in the 2(nd) and the control group. In the ADAL-1(R) group there were significant statistical differences between 1(st) and 4(th) week (p=0.0002). In the 2(nd) group, 80% of the muscles were attached to the planed position and 20% were slightly displaced, while in the control group 90% of the muscles were attached to the planed position, and 10% were slightly displaced, however there is no significant difference between the two groups p=0.5 (Fisher's Exact Test). CONCLUSION: ADAL-1(R), a new adhesive, could replace sutures in strabismus surgery, giving rise to a rapid and efficient adhesion between muscles and sclera and well tolerated by the ocular tissues.

Animals↗

PubMed1975

Current concepts in the management of strabismus in children with cerebral palsy.

Few guidelines have been advanced for the management of brain damaged children with strabismus. Conservative therapy with lenses, prisms, occlusion, atropine and late surgery has been suggested but without specific methods or ages being advocated. The authors undertook the treatment of these children utilizing the standard principles of strabismus therapy as applied to neurologically normal children. A further consideration is a satisfactory cosmetic appearance which wins greater self, peer and parental acceptance in these handicapped children. The results of therapy of this series of patients with cerebral palsy indicates that satisfactory alignment can be achieved in the majority even in the presence of severe motor involvement and/or mental retardation. Ninety percent of those patients with treated accomodative esotropia achieved a satisfactory alignment. Those patients with non accommodative esotropia had a satisfactory alignment in 77% of the patients operated upon and those with exotropia achieved this result in 86% of the patients operated upon. Only five (2%) patients spontaneously reduced their angles to cosmetically acceptable ranges. Overcorrections occurred in 10 (11%) patients in the surgically treated nonaccommodative esotropes and 4 (3%) of these patients required further corrective surgery. Only one exotropic patient was rendered esotropic postoperatively. The average age of initial surgery in the esotropic patients was 3.9 years and 5.7 years in the exotropic patients. The older ages for surgical intervention reflects the more conservative approach to these neurologically abnormal children and allow an increased time interval for the development of a stable preoperative oculomotor alignment.

Adolescent↗

PubMed2002

[Accuracy of suture adjustment in sliding noose type adjustable strabismus surgery].

PURPOSE: To clarify the efficacy of adjustable suture strabismus surgery with sliding noose, we evaluated the accuracy of suture adjustment. METHODS AND SUBJECTS: Thirty-four patients with various types of strabismus participated [age range: 12-79 years, range of far deviation: 4-123 prism diopters(PD)]. Under sub-Tenon anesthesia, a recession(with or without an additional resection or a muscle transposition) was performed with an adjustable suture(Guyton's procedure), and the suture was adjusted 6-24 hours after the surgery. Based on the initial postoperative examination performed 1-4 weeks(mean: 2.8 weeks) after the surgery, errors in the far deviation from the individual target were analyzed. RESULTS: Twenty-six(76%) patients required suture adjustment 1-8 times. In 50% and 75% of our patients, the errors were within +/- 0.8 and +/- 2.0 PD, respectively, whereas 2(6%) patients with esotropia showed an undercorrection larger than 10 PD. Distribution of the errors was the same throughout the range of pre-operative deviation. CONCLUSION: By using the sliding noose type adjustable suture, a pin-point alignment of the eyes can be established in more than 50% of cases, at least, in the early post-operative period.

Adolescent↗

PubMed1975

[The results of surgical treatment of convergent strabismus (author's transl)].

From the results of 628 operations on strabismus convergens, the individual corrections were related to the achieved reduction of the angle of deviation. The evaluation showed that strabismus operations may be well dosed not only with a view to a general improvement of the squint angle but also as a specific influence on the squint angle as to distant vision and near vision.

Anesthesia, General↗

PubMed2002

Recession and measured, graded anterior transposition of the inferior oblique muscles for V-pattern strabismus: outcome of 44 procedures in 22 typical patients.

PURPOSE: This study aimed to evaluate the efficacy of recession and graded anterior transposition of the inferior oblique (IO) muscle to correct or to reduce V-pattern strabismus and associated IO overaction. METHODS: The technique used was that proposed by Wright, using the temporal border and the insertion of the inferior rectus as the reference points to locate the new insertion. In a retrospective study, 51 patient histories were analyzed and from this group, 22 patients were selected as most typical examples. Patients with hypertropias greater than 6 prism diopters (PD), a dissociated vertical deviation (DVD) greater than 8 PD or decompensated DVD were excluded. RESULTS: A total of 44 eye surgeries on 22 patients were analyzed. We observed favorable results ("statistically significant") concerning the reduction of the IO overaction or V incomitance. In 45.5% (20 eyes) the IO function was normalized, in 15.9% (7 eyes) there was a reduction to -1 (underaction) and in 34.1% (15 eyes) there was a reduction, but there still remained a +1 overaction. In 77.3% of the patients there was a "satisfactory" outcome of the V pattern, defined as a residual incomitance less than 10 PD. CONCLUSION: In this group of patients with V-pattern strabismus and IO overaction, the recession and measured, graded anterior transposition based on Wright's technique showed satisfactory results ("statistically significant") in correcting the V incomitance and normalizing or reducing the IO overaction.

Adolescent↗

PubMed2002

[The effect of ketamine on reducing postoperative agitation after sevoflurane anesthesia in pediatric strabismus surgery].

We investigated the effect of ketamine on reducing postoperative agitation after sevoflurane anesthesia in children undergoing elective strabismus surgery. Fifty-five children, 3-9 years of age, were randomly assigned to the following three groups; ketamine (group K, n = 18), pentazocine (group P, n = 19), and flurbiprofen axetil(group F, n = 18). Group K received ketamine 1 mg.kg-1 intravenously, followed by infusion of ketamine 1 mg.kg-1.hr-1 during surgery, group P received pentazocine 0.2 mg.kg-1 intravenously after induction of anesthesia, and Group F received intravenous flurbiprofen axetil, 1 mg.kg-1 5 minutes before the end of surgery. Agitation (evaluated by Aono's four-point scale; AFPS) and awareness (evaluated by Steward score) were assessed just before tracheal extubation(T 1), 5 minutes after tracheal extubation(T 2), arrival at the ward(T 3), and 60 minutes after arrival at the ward(T 4). We considered AFPS > or = 3 patients as "agitated" and APFS < or = 2 patients as "not agitated". At T 1 and T 2, the incidence of agitation(AFPS > or = 3) in group K was less than that of group F and group P. However, in group K, more patients needed oxygen supplement after extubation. We concluded that coadministration of ketamine could be beneficial for reducing postoperative agitation after sevoflurane anesthesia in pediatric strabismus surgery.

Anesthesia Recovery Period↗

PubMed1992

[Strabismus and stereopsis in children].

43 strabismus children 5-12 years old were successfully corrected with surgery plus synoptoscope functional training before and after the operation. They were followed up for an average 2 years: 38 cases (88.4%) obtained qualitative stereopsis with the synoptoscope, and 14 cases (32.6%) obtained central stereoacuity with Yan's stereoscopic test charts. The results indicated that early surgical intervention plus functional training before and after the operation was an effective means to raise the functional cure rate of strabismus in children. The two methods of synoptoscope and Yan's stereoscopic test charts and their clinical significance were discussed.

Child↗

PubMed1959

Surgical treatment of convergent strabismus.

In convergent strabismus, glasses, visual training and exercises are often helpful, but operation is usually needed in addition to produce a functional or cosmetic cure. Babies who are born cross-eyed should be examined early and nonsurgical treatment started so that proper visual appreciation will be developed in both eyes. Children in whom strabismus develops some time after birth (usually between 18 months and six years of age) should be examined with atropine, glasses prescribed when indicated and full medical treatment instituted. If those measures fail, operation should be done on one or both eyes, the operation depending on the magnitude of the deviation.

Atropine↗

PubMed2003

[Surgery for strabismus secondary to ethmoid sinus surgery].

PURPOSE: To review the outcome of surgery for strabismus due to ethmoid sinus surgery. CASES AND METHODS: The series comprised 13 cases, 1 of inferior rectus paresis, 1 of superior oblique paresis, 6 of medial rectus paresis, and 5 of medial rectus muscle palsy due to third nerve palsy. In the cases of paresis of the rectus muscle, resection of the rectus muscles was mainly performed. In the cases of palsy of the rectus muscle, transposition of the extraocular muscle with simultaneous recession of the lateral rectus muscle was performed. The major aim of surgery was to bring both eyes into alignment and to eliminate diplopia in the primary position. RESULTS: The mean preoperative horizontal deviation of 18.1 degrees of exotropia in the paresis cases was reduced to 1.4 degrees of exotropia after surgery. The mean preoperative vertical deviation of 3.8 degrees of hypertropia was reduced to 1.4 degrees of hypertropia postoperatively. The mean preoperative horizontal deviation of 35.6 degrees of exotropia in the palsy cases was reduced to 9.4 degrees of exotropia after surgery. The mean preoperative vertical deviation of 2.0 degrees of hypertropia was increased to 2.6 degrees of hypertropia postoperatively. Postoperatively, diplopia was absent in 11 cases with a slightly compensatory head posture. CONCLUSION: Surgery for strabismus due to sinus surgery induces improvements in eye position and diplopia.

Adult↗

PubMed1992

[The effect of horizontal strabismus surgery on the refractive status in children].

The refractive changes in 84 children (155 eyes) following horizontal strabismus surgery and in 97 children (181 eyes) without surgical intervention were studied. The results indicated that the spherical refraction and axis of astigmatism were not significantly affected by the operation, especially when both recession and resection were done on the same eye; however, the cylindrical refraction changed markedly within 6 weeks of surgery. These changes would be minimized and become stable 6 weeks after the operation, suggesting that the proper time for a cycloplegic refraction was 6 weeks after a horizontal strabismus surgery.

Adolescent↗

PubMed2003

Eight eye muscle surgical treatment in a patient with acquired nystagmus and strabismus: a case report.

The purpose of this paper is to outline the clinical benefits and electrophysiological changes after extraocular muscle surgery for acquired nystagmus and strabismus in an adult patient. a 41-year-old Caucasian female suffered from oscillopsia, bilateral cranial nerve IV palsies, and vertical nystagmus. Medical therapy was ineffective. She underwent bilateral, eight muscle surgical procedure which included: tenectomies of the superior oblique OU, myectomies of the inferior oblique OU, recessions of the medial rectus muscles OU (with OD on a post-operatively adjustable suture), and differential recessions of the superior rectus muscles OU. This provided marked improvement in her symptoms. These results suggest that surgery for acquired nystagmus can affect an improvement in the characteristics of the nystagmus that result in visual complaints. Combining "nystagmus surgery" plus strabismus surgery may be a viable option in some adult patients with acquired nystagmus who are unresponsive to medical therapy.

Adult↗

PubMedDate not supplied

[Changes in the horizontal angle in strabismus after surgery of the vertical ocular muscles].

We have operated 79 children with vertical strabismus. We have treated 52 children with primary overaction of the inferior oblique muscles and 27 of them with DVD and primary overaction of the inferior oblique muscles. In all of them, we have done recession of the inferior oblique muscles (for 4, 6, 8 or 10 mm). In only seven of them, from the second group, we did recession of the superior recti (for 7, 8 or 9 mm) simultaneously. This surgery very significantly and adequately ameliorate vertical strabismus (p = 0.004). Mentioned surgery on vertical extraocular muscles theoretically may product more esodeviation. In our practice with 79 operated children we didn't prove that (p = 0.148).

Adolescent↗

PubMed2003

[Strabismus surgery of the myopic patient under topical anaesthesia].

PURPOSE: To study the epidemiological characteristics and the results of strabismus surgery of high myopic patients under topical anaesthesia. METHOD: Retrospective study of nine high myopic patients with restrictive myopic myopathy (RMM) that underwent surgery in the last year and with a minimum follow-up of at least 6 months following surgery. Clinical findings, alteration of the extrinsic ocular motility (EOM) and response to surgical treatment were evaluated in each case. RESULTS: RMM was more frequent in women, average age was 46 years and average refractive error was 14 diopters. Diplopia was the most frequent reason for consultation, followed by the wish to undergo surgery because of an aesthetically unacceptable strabismus. High myopia was the most frequent etiology. One case was secondary to decompensated fourth cranial nerve palsy. The alteration of the EOM more frequently observed was endotropia associated with hypotropia. The recurrence rate of the deviation was 44%, occurring generally in the immediate postoperative period. In these cases botulinum toxin is a valid treatment option. CONCLUSIONS: Topical anaesthesia offers undoubted advantages for a better adjustment of diplopia in RMM surgery. During the intraoperative adjustment it is convenient to overcorrect the horizontal deviation and to undercorrect the vertical deviation.

Adult↗

PubMed2003

[Indications for refractive procedures in adult patients with strabismus and results of the subsequent therapeutic procedures].

The authors estimated the contribution of the refraction intervention and a possible evolution in the position of eyes in 102 adult individuals considering a refraction intervention. The indications for this intervention were a disorder in eye position or amblyopia in those who were interested in this operation and were examined in the years 1996 to 2002. The basic refraction examination was always supplemented by a detailed orthoptic analysis. Based on this examination the intervention was not recommended in 14 examined subjects (14%). ARK represented the contraindication of the refraction intervention in 9 patients, since subsequent changes in the size of the deviation or operation adjustment of strabismus could result in diplopia. An excessive convergence with a high AC/A in hyperopia was also considered as an unsuitable indication, since a lasting cosmetic and functional significant convergent deviation into near distances could not be excluded. Five patients declined from the refraction intervention on the basis of this explanation. The paper is mainly dealing with an analysis of the development of position of the eyes and binocular functions in 46 adult patients, who decided to undergo a refraction intervention and further orthoptic care after a complex stroboscopic and refraction examination. The adjustment of refractive error was made by the LASIK methods (Laser in Situ Keratomileusis) on 69 eyes (80%) and CLE (Cleans Lens Extraction) on 17 eyes (20%). The orthoptic analyses before and the refraction intervention revealed that in all 29 even only partially accommodating esotropia, the deviation was diminished after the refraction intervention on the average by +11.2 degrees (in the rage of +2 degrees to +30 degrees) to 5.4 degrees (in the range of parallel position to +20 degrees) in the predominantly represented hyperopia, but also in 6 myopias. The improved position of the bulbs was not directly associated with the degree of hyperopia with the original deviation. The deviation after the refraction intervention in 23 patients (79%) with esotropia was not higher than degrees. The cosmetic position of the eyes was completely satisfactory and did not therefore represent even indication for the operation. The 9 patients (35%) with esotropia and hyperopia there were an improvement of binocular functions. It could be theoretically due to the newly developed emetropia making permanent optimal sensory information possible. In all 17 exotropias there were not any significant changes in the size of deviation and the binocular functions were not reestablished, if they were not retained before. The position of eyes was solved surgically in 12 patients, while exotropia predominated in two thirds of them. The weakening or strengthening interventions on horizontal straight muscles were selected according to character of strabismus in 11 patients. Recession of the lower oblique muscle was indicated one case only for the simultaneously present torticollis with exotropia. The residual deviation was not greater than 5 degrees immediately after the operation or during the following months. Binocular functions were not reestablished in any patients. A alternate suppression or suppression of perception on one eye were proved.

Adult↗

PubMed1992

A prospective, randomized, controlled comparison of retrobulbar and general anesthesia for strabismus surgery.

A prospective, randomized controlled study (n = 95) was conducted to compare the morbidity and length of hospital stay associated with retrobulbar neuromuscular blockade (LA) with that associated with general anesthesia (GA) for monocular strabismus surgery in adult patients. A scoring system was developed to assess postoperative nausea and vomiting, pain, level of consciousness, oral intake, and activity while in the hospital and for the first 3 postoperative days. There was no significant difference in the postoperative nausea and vomiting associated with the two anesthetic techniques. Although patients receiving LA experienced less immediate postoperative discomfort (P < .01) and had greater levels of activity (P < .0001) while in the hospital, the discomfort and activity levels of the two groups were similar at home. The LA group was discharged from the hospital sooner (mean, 135 minutes vs 250 minutes; P < .001), allowing more efficient use of hospital resources. Both techniques provided excellent anesthesia for monocular strabismus surgery.

Adolescent↗

PubMed2004

Treatment for A and V strabismus by slanting muscle insertions.

PURPOSE: To evaluate the therapeutic effects of surgically slanting extraocular muscle insertions. RESEARCH DESIGN: Observational case series. METHODS: We performed slanting recession and resection on medial or lateral rectus muscles. We created a slanting surgical reinsertion line with a 3-4 mm difference between upper and lower corners of the muscles, in 31 patients with A or V strabismus (V exotropia in 16 patients; A exotropia in 12; A esotropia in 3). Cases with V exotropia with moderate or marked overaction of inferior oblique muscle were excluded. RESULTS: V exotropia: The average amount of V pattern was 17.9 PD before and 7.6 PD after surgery. Slanting surgery reduced the V pattern in 15 of 16 patients. The mean amount of reduction was 10.3 PD in the V pattern and 29.8 PD in upgaze. A exotropia: The average amount of the A pattern was 26.6 PD before and 6.3 PD after surgery. Slanting surgery reduced the A pattern in 8 of 12 patients. The mean reduction was 20.3 PD in the A pattern and 36.4 PD in downgaze. A esotropia: The average amount of the A pattern was 23 PD before and 8 PD after surgery, reducing the A pattern in 1 of 3 patients. CONCLUSION: The surgical technique of slanting muscle insertions for correction of A and V strabismus is a suitable procedure for reducing or eliminating A and V patterns.

Adolescent↗

PubMed1992

[Surgery of strabismus performed during topical anesthesia using adjustable sutures].

Retrobulbar, peribulbar and general anaesthesia for strabismus operations all share the disadvantage that they do not permit preoperative evaluation of the effect of the operation. To overcome this problem, we now operate selected cases in topical anaesthesia, using adjustable sutures. In addition to using adjustable sutures in recession, we have developed a method of adjustable resection. During a six month period, 70% of our grown-up patients were operated by this method. We find it a useful supplement to traditional strabismus surgery, also in reoperations and in operations on paretic muscles.

Anesthesia, Local↗