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PubMed1988

A sequential strategy for achieving functional binocularity in strabismus.

The clinical approach to achieving functional binocularity for constant strabismus includes a series of sequential steps utilizing several therapy options. Passive therapy includes lenses, prisms, filters, occlusion, medications and strabismus surgery. Active therapy adds visual exercises and/or self-monitoring systems such as biofeedback. Consideration of commonly used options and an overall sequential strategy is presented as a practical guide to the successful management of strabismic patients.

Amblyopia↗
PubMed1987

Orbital cellulitis following strabismus surgery.

Orbital cellulitis is a rare complication of extraocular muscle surgery. Two cases have been reported since 1935. No report of this sight-threatening and life-threatening complication of strabismus surgery has appeared since computerized tomography became readily available. The following is a report of a case of orbital cellulitis occurring unilaterally following bilateral strabismus surgery in which computerized tomography was helpful in verification and management. Early antibiotics resulted in a favorable outcome. The case is compared to those reported by von Noorden.

Cefotaxime↗
PubMed1987

The use of sodium hyaluronate as a biologic sleeve in strabismus surgery.

Strabismus surgery sometimes fails because of the mechanical restriction caused by the development of fibrous adhesions between the operated muscle and the surrounding tissues. Reoperation increases the frequency and severity of mechanical restriction significantly because of additional scar formation. Attempts to isolate the muscle from other tissues using gelatin sponges or Supramid plastic sleeves have been unsuccessful because of the body's reaction to these permanent foreign bodies. We used an ultra-pure fraction of sodium hyaluronate to study whether this nonantigenic, noninflammatory, viscoelastic substance could function as a temporary sleeve to prevent or reduce scarring and mechanical restriction following strabismus surgery. We resected the superior rectus muscle of 14 eyes from seven 5- to 7-pound white rabbits. In one eye, we instilled sodium hyaluronate 1% around the muscle. The other eye served as a control. The rabbits were killed at five, seven, ten, 14, 21, 28, and 42 days. Ante mortem length-tension measurements and post mortem histologic examinations of the operated muscles were performed in a blinded fashion. The results suggested, but did not definitely demonstrate, that sodium hyaluronate may reduce postoperative adhesions.

Animals↗
PubMed1985

Adjustable-suture strabismus surgery: a review of 255 consecutive cases.

Adjustable-suture strabismus surgery was performed on 255 patients under general anesthesia. Prophylactic topical and oral antibiotic therapy was used in all cases; only one postoperative infection occurred. Adjustments were needed for 123 patients and were done under topical tetracaine anesthesia within a few hours after recovery from general anesthesia. Overall the adjustments appeared to be reliable. The use of droperidol, however, made reliable adjustment impossible in two cases and is therefore strongly contraindicated if suture adjustment is to be done within a few hours of general anesthesia. There were two cases of temporary palsy of the muscle with the adjustable suture, presumed to be due to the topical anesthetic. Unexpectedly large effects of the surgery occurred in three cases of acquired sixth cranial nerve palsy in which full abduction had been recovered but a concomitant esotropia remained and in a few cases in which the muscles had previously been resected and there were normal active ductions preoperatively. Contraindications to the use of adjustable sutures in strabismus surgery may include multiple orbital fractures, previous orbital floor decompression for dysthyroid ophthalmopathy, and a variable angle.

Adolescent↗
PubMed1983

The oculocardiac reflex in strabismus surgery.

During strabismus surgery on 81 extraocular muscles in 49 children the cardiac response to calibrated traction on each of the muscles operated on was studied through the use of a microdisplacement transducer and the tachometer of a cardiac monitor. There was no significant difference in the frequency of induction of the oculocardiac reflex between the medial rectus and the other muscles or between the two eyes. However, quick traction provoked a reflex in 87% of instances, whereas progressive traction did so in only 51% of instances, a significant difference (p less than 0.05). Thus, because the oculocardiac reflex is frequent during strabismus surgery, cardiac monitoring during the operation and minimal, gentle manipulation of the extraocular muscles are important.

Child↗
PubMed1982

Adjustable sutures in strabismus surgery.

The results of conventional strabismus surgery are always somewhat uncertain, despite the most careful preoperative assessment. Yet it is important to achieve good alignment in patients with fusion potential who have intermittent exotropia, extraocular muscle paresis or a restrictive syndrome. Planning surgery for patients with thyroid myopathy and planning reoperations is particularly difficult. In 30 patients with various strabismus disorders the use of adjustable sutures proved safe and of value; the results were unacceptable in only 5 of the 28 patients with horizontal deviations. The inconvenience for the surgeon and the extra discomfort for the patient seemed outweighed by the predictability of the surgical result.

Adult↗
PubMed1983

Concomitant strabismus as a sign of intracranial disease.

A child with a postoperative residual estropia of 16 diopters was suddenly found to have 75 D of esotropia for distance and 65 D of estropia for near. Full versions were noted that would be inconsistent with sixth nerve palsy. Divergence palsy is characterized by a substantially larger convergent strabismus for distance that, in this case, was only 10 D. One is left with the conclusion that concomitant strabismus may indicate the onset of intracranial disease that, in this case, was caused by an arteriovenous malformation.

Brain Edema↗
PubMed1980

Multiple operations for strabismus.

Some examples will be noted where the strabismus surgeon plans the patient to have more than one operation. Unfortunately most multistage strabismus procedures are unplanned and are a consequence of failure of the initial surgery. The three most common causes of such failure will be discussed. Brief mention will be made of the more important surgical techniques for rectus muscles that have had repeated operations.

Adult↗
PubMed1982

Mortality rate in strabismus surgery.

Strabismus surgery has been viewed as being associated with a high degree of mortality. Many past studies have used small surgical samples and have stressed the various theoretical causes of the deaths rather than view the procedure from a statistical and scientific standpoint. We present here a large series of surgical cases collected nationwide showing that strabismus surgery is a relatively safe procedure associated with a mortality less than that of a tooth extraction.

Adolescent↗
PubMed1982

[Psychological repercussions of strabismus in children].

Psychomotor and behavioural disorders in 55 strabismic children are analyzed. Examinations were conducted either before or after surgery, or both before and after the operation (9 cases). Lateralization, quality of motricity, and school adaptation differed only slightly from those of pupils of the same age, in contrast to findings in previous studies. Behaviour, marked by inhibition, anxiety, and emotional disorders, improved after surgery, as shown by modifications in drawings which reflect disturbances due to strabismus and the wearing of spectacles. No correlation was found between affective disorders and ophthalmological features, the essential cause of these disorders being the manner in which others look at the child. The fact that strabismus reduces esthetic appearances is not the only reason, the symbolic nature of the eye and gaze being associated factors. Social adaptation improves after surgery, but drawings are still not completely normal. Preventive measures are proposed.

Adaptation, Psychological↗
PubMed1978

Strabismus therapy in private practice: Cure rates after three months of therapy.

In this study, a random strabismus sample of 86 strabismus therapy patients meeting certain criteria was evaluated. The roles of retinal correspondence, amblyopia, eccentric fixation, prior surgeries, type and magnitude of deviation, number of therapy sessions undertaken, age at onset of therapy, and academic difficulties were scrutinized to see how they affect prognosis for functional cures(Flom's criteria), cosmetic cures (angle less than, or equal to 15 prism diopters) and total cures; the sum of functional cures and cosmetic cures.

Adolescent↗
PubMedDate not supplied

Effects of intraoperative topical mitomycin-C on strabismus surgery in the rabbit: a preliminary study.

The effect of intraoperative topical exposure of mitomycin-C (MMC) on muscle reattachment and scarring in strabismus surgery was prospectively investigated in the rabbit by performing bilateral recession surgery in which one eye was treated with topical MMC (0.2 mg/mL) and the other eye served as the control. One week postoperatively, in random, masked fashion, the severity of postoperative adhesions was rated lower in the MMC-treated eyes. Also, histology demonstrated decreased fibrosis in the muscle reattachment sites in the MMC-treated eyes. The muscle tension in the reattached muscles was greater than 100 g in all of the eyes. This preliminary study indicates that topical MMC exposure may inhibit scarring in strabismus surgery without inhibiting muscle reattachment or causing other obvious adverse effects.

Administration, Topical↗
PubMed1993

The routine use of adjustable sutures in adult strabismus surgery.

A review is given of the adjustable suture technique in adult strabismus surgery, and our experience with its use over a 4-year period. Twenty patients underwent adjustable surgery during that time, both for cosmetic reasons and for alleviation of diplopia. Postoperative adjustment in the alert patient enabled the eyes to be aligned in the most favourable position. The stability of alignment was good, and a success rate of 85% was achieved over a mean follow-up period of 17 months. Our results demonstrate the value of the technique, even when undertaken in a non-specialist ophthalmological department of a district general hospital. We now offer adjustable sutures routinely to all adults able to cooperate, to safeguard against the unpredictable nature of standard strabismus surgery.

Adolescent↗
PubMedDate not supplied

[Strabismus determined by anatomical changes in the extrinsic ocular muscles].

The anatomical primitive strabismus is prenatal and its characteristic is the loose in the elasticity of the muscles of the surrounding tissues. The cause is the deficit of embryogenesis, originating in the first two months of pregnancy. They are presented the clinical cases of anatomical strabismus, investigated and treated in the Ophthalmological Clinic during 10 years, the surgical techniques used and the postoperative functional and obstetrical results the ocular disturbances are intense and the debut is early. The surgery involves both eyes and the results depend on the clinical form, the restant ocular motility and the degree of fibrosis of the affected muscle.

Diagnosis, Differential↗
PubMed1994

MR imaging in patients with strabismus.

The patients with strabismus, including 8 with superior oblique paresis, 1 with inferior rectus paresis, and 1 with congenital constant exotropia, were examined with MR imaging at 1.5 tesla (T) or 0.5T with a surface coil. Abnormal findings of extraocular muscles were identified in 8 of the 10 patients and most of them were consistent with the clinical findings. Deviation of the optic nerves was noted in 5 patients. Coronal short repetition time (RT) and echo time (ET) images were used to measure the concerned extraocular muscles and the optic nerves. The differences in diameters between the concerned extraocular muscles of both the diseased and normal eyes were calculated. MR imaging is considered to be advantageous and can be favorably used to observe and measure the extraocular muscles and other intraorbital structures in patients with strabismus.

Adult↗
PubMed1994

Antiemetic prophylaxis for strabismus surgery.

Droperidol can reduce the high incidence of vomiting after pediatric strabismus surgery; however, its use may be associated with sedation, delayed hospital discharge, dysphoria and extrapyramidal signs. Midazolam, a short-acting benzodiazepine with antiemetic properties, has few side effects and may be a suitable alternative. We prospectively compared the antiemetic effect of these two drugs in 393 healthy children aged 18 months to 14 years undergoing outpatient strabismus surgery. The children were randomly assigned to receive midazolam hydrochloride (50 micrograms/kg) (199 patients) or droperidol (50 micrograms/kg) (194 children). The incidence rates of vomiting in the two groups were 45% and 37% respectively, a nonsignificant difference. The incidence of vomiting was not affected by the duration of anesthesia, but the number of muscles repaired was a significant predictor of postoperative vomiting (p < 0.001).

Adolescent↗