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PubMed2003

[Prophylaxis of postoperative nausea and vomiting (PONV) in children undergoing strabismus surgery. Sevoflurane/N2O plus dimenhydrinate vs.propofol/remifentanil plus dimenhydrinate].

UNLABELLED: BACKGROUND AND STUDY GOALS: Strabismus surgery in children is frequently associated with a very high incidence of postoperative nausea and vomiting (PONV). In this study we investigated, whether TIVA is superior to inhalation anaesthesia concerning PONV when a prophylaxis using dimenhydrinate (diphenhydramine chlorotheophyllate) is administered in both groups. METHODS: 110 patients (3-10 years) were prospectively and randomly allocated to one of the following groups: Group TD (TIVA/dimenhydrinate; n= 55): anaesthesia was induced and maintained using remifentanil and propofol in common clinical dosages. Patients were ventilated with 30% O(2) in air. Group VD (Volatile/ dimenhydrinate; n= 55): anaesthesia was induced and maintained with sevoflurane in common clinical concentrations together with N(2)O in 30% O(2). All patients received dimenhydrinate 1 mg.kg(-1) i.v. after induction. PONV was recorded within the first 24 h postoperatively. The chi-square test and a multivariate analysis were used for statistical analysis. RESULTS: 52 patients of group TD and 54 of group VD were analysed. There was a trend in the incidence of postoperative nausea (PN): group TD 17%, 95% CI: 8-30%) compared to group VD 31%, 95% CI: 20-46%), p = 0.09. No difference was seen for PV and PONV: 21% (95% CI: 11-35%) in group TD vs. 35% (95% CI: 23-49%) in group VD, p = 0.109. These non-significant results can be easily attributed to the lack of power about 30%) of this study. According to the results of the multivariate analysis volatile anaesthesia was identified as an independent risk factor for PONV (OR: 2.92, 95% CI: 1.02-8.36). Other variables that were found to be an independent risk factor included history of PONV (OR: 8.19, 95% CI: 1.84-36.43), surgery lasting longer than 30 min (OR: 5.89, 95% CI: 1.82-19.82) and "Faden-operations" (retroequatorial myopexy) (OR: 5.48, 95% CI: 1.74-17.21). CONCLUSIONS: TD only showed a trend to lower PN incidences and no differences as for PV and PONV incidences, most likely due to a lack of power of this study. However, according to the results of the multivariate analysis, inhalation anaesthesia was shown to be an independent risk factor for PONV, as were history of PONV, surgery >30 min and "Faden-operations".

Anesthesia, Inhalation↗
PubMed2002

Distribution-dependent saccades in children with strabismus and in normals.

To guide saccades accurately human adult subjects learn rapidly to aim, in advance, for the central position of the distribution of the target positions studied. This causes a bias called range effect, i.e., saccades to the central location are accurate while the less eccentric locations are overshot and the more eccentric locations are undershot. It is believed that this is a cognitive strategy allowing to reduce overall variability. We show here that the same exists for normal children (5-13 years old). Most importantly, from the age of 5 years, children with strabismus use the same cognitive strategy despite the fact that their eyes are misaligned. Importantly, both eyes follow this strategy even though only one eye is fixating the target (the other eye being squinted).

Adolescent↗
PubMed1975

Retinal detachment after strabismus surgery.

Four nonmyopic eyes in three patients developed retinal detachment after strabismus surgery. Certain features common in all four eyes included the presence of a chorioretinal scar corresponding in location to the muscle operated on, proliferating fibrous tissue adjacent to the scar, and varying degrees of vitreous hemorrhage. These findings were similar to those in retinal detachments after perforation of the eye by foreign bodies. Penetration of the globe by the needle during muscle surgery was considered the etiologic factor. The use of spatula needles to prevent piercing of the globe is suggested, and in case such accident is suspected, diathermy or cryoapplication over the perforation site is advised.

Adult↗
PubMed1975

Brief hospital admissions for pediatric strabismus surgery.

We performed strabismus surgery on 170 children on an outpatient basis. Endotracheal intubation was utilized in all cases as the means of delivery of the anesthetic agent. Atropine used alone as a preoperative medication reduced the incidence of postoperative vomiting. Parental acceptance of this method of surgery was best when the child was discharged from the hospital awake and alert in the shortest possible time.

Adolescent↗
PubMed1975

Strabismus and pseudostrabismus with retrolental fibroplasia.

Three patients with temporal displacement of the macular secondary to retrolental fibroplasia had true strabismus in associations with amblyopia and pseudostrabismus related to a large, positive angle kappa. In one case, a headturn associated with the neutral point of nystagmus was also a presenting problem. Ocular deviation was measured by the light reflex test and the prism cover test, with particular attention paid to adequate cosmetic alignment. Large amounts of prism placed before the fixating eye resulted in loss of visual acuity, while eyes placed in a parallel position by surgical means may not appear to be straight. Thus, surgery can result in parallel ocular alignment while prismatic therapy may be required to center the pupillary light reflex and to provide satisfactory cosmetic appearance.

Accommodation, Ocular↗
PubMed1977

Eye position of strabismus patients under general anesthesia.

We studied the change in eye position under general anesthesia in 317 patients undergoing strabismus surgery. We used the prism cover test to measure preoperative eye position, and the prism reflex test (Krimsky's method) to measure the eye position under general anesthesia. Almost all patients had divergence under anesthesia. We calculated a linear equation and curve to relate the eye position under anesthesia to the preoperative eye position. Patients with a normal amount of divergence (within one standard deviation of the mean) had a higher rate of successful surgical results than those with an abnormal amount of divergence under anesthesia (greater than one standard deviation from the mean).

Adolescent↗
PubMed1982

Endophthalmitis after strabismus surgery.

We treated two cases of endophthalmitis caused by strabismus surgery. In one patient, a scleral perforation was recognized during surgery and treated with cryopexy. In the other, a scleral perforation was suspected but never confirmed. Despite intensive antibiotic and corticosteroid therapy, visual acuity decreased to light perception in Case 1 and to counting fingers in Case 2. The second eye was enucleated eight years later after it had become blind and painful.

Adolescent↗
PubMed1984

The Pulfrich effect in anisometropic amblyopia and strabismus.

Using a device based on the Pulfrich effect, we examined 70 patients with various strabismus problems and 20 normal subjects for gross stereopsis. We found an excellent correlation between this dynamic stereopsis test and random dot stereograms. Additionally, in several instances the Pulfrich device was easier to use and interpret correctly than random dot stereograms. The Pulfrich effect can be elicited reliably in patients as young as 3 1/2 years of age. Three patients with anisometropic amblyopia and stereopsis were found to possess a spontaneous Pulfrich effect.

Adolescent↗
PubMed1987

Oculocardiac reflex during manipulation of adjustable sutures after strabismus surgery.

We studied 44 patients who underwent strabismus surgery with the use of adjustable sutures to determine the occurrence of the oculocardiac reflex during the postoperative adjustment process. We defined the reflex as at least a 10% decrease in the baseline heart rate. Only two patients (4.5%) displayed an oculocardiac reflex during the adjustment. We did not identify any preadjustment factors that would increase the susceptibility to develop the reflex.

Adolescent↗
PubMed1983

Optically induced strabismus results in visual field losses in cats.

Kittens were reared using goggles containing a prism that simulated a convergent strabismus. A bilateral loss of 30 degrees of the contralateral monocular visual field resulted, indicating that the components of the visual pathways representing the nasal visual field are more sensitive to spatially conflicting visual inputs than the components representing the temporal field. Differences in the extent of binocular visual fields occurred, with alternating fixators demonstrating a full field and unilateral fixators demonstrating a binocular field reduction ipsilateral to the deviating eye.

Animals↗
PubMedDate not supplied

Anterior segment ischemia after strabismus surgery.

Surgery on the extraocular muscles of the eye is generally consisted a safe procedure which is associated with low morbidity and mortality. While infrequent, intra-operative complications occasionally occur. Tenotomy of multiple rectus muscles can result in interruption of the vascular supply to the anterior segment of the eye. Anterior segment ischemia (ASI) may result. This article reviews the complication of anterior segment ischemia as a result of strabismus surgery and its potential for producing permanent visual loss.

Anterior Eye Segment↗
PubMed1996

Components of visual acuity loss in strabismus.

Strabismus, the misalignment of the visual axis of one eye relative to that of the other eye, reduces visual acuity in the affected eye. Several processes contributing to that loss are: amblyopia, which results in a chronic acuity loss whether or not the fellow eye is viewing; strabismic deviation, which shifts the image of an acuity target onto more peripheral, and therefore less acute, retina when the fellow eye fixates; interocular suppression and binocular masking, which reduce visibility in the strabismic eye due to neural influences from the other eye. We measured the losses due to these processes in nine small-angle strabismic subjects. Amblyopia reduced acuity by a median of 34% relative to its value in subjects with normal binocular vision, and strabismic deviation produced a loss of 44%. Suppression and masking together reduced acuity by 20%, and therefore had substantially less effect than the other factors.

Adolescent↗
PubMed2005

The use of Surgi Wrap in delayed adjustable strabismus surgery.

PURPOSE: To determine the effect of Surgi Wrap (MacroPore Biosurgery, Inc, San Diego, California, USA) in delayed adjustable strabismus surgery. DESIGN: An animal study. METHODS: A prospective, masked-observer, controlled study was performed in rabbits. Forty-eight eyes of 24 rabbits were divided into two groups. After recession of the superior rectus muscle (SRM), Surgi Wrap was applied beneath and over the SRM in the Surgi Wrap group, and no barrier was applied in the control group. Delayed adjustment was performed once on each superior rectus muscle at 1, 2, and 3 weeks after surgery by a masked observer. The possible length to adjust, the force required for the adjustment, and the degree of any adhesions were also evaluated. RESULTS: In the control group, adjustment was impossible in all of the five eyes at 1, 2, and 3 postoperative weeks, respectively. In the Surgi Wrap group, adjustment was possible in four of 10 eyes at 1 week after surgery, in two of 10 eyes at 2 weeks after surgery, and in none of the 10 eyes at 3 weeks after surgery. CONCLUSION: The use of Surgi Wrap could delay adjustment in some of the eyes up to 1 or 2 weeks after surgery. Surgi Wrap could be helpful for short-term delayed adjustment in rabbit eyes.

Animals↗
PubMed2004

An evaluation of the semiadjustable suture strabismus surgical procedure.

BACKGROUND: Muscle slippage is an adverse outcome of strabismus surgery. Its incidence is increased if adjustable sutures are used or if surgery is performed on the inferior or medial rectus muscles. Although there are no firm numbers for this complication, studies have suggested incidence rates between 7% and 41% when adjustable suture surgery is performed on the inferior rectus muscle. In theory, the semiadjustable suture procedure should decrease this adverse outcome. This procedure involves suturing the corners of the muscle firmly to the sclera and placing the center of the muscle on an adjustable suture. This study evaluates semiadjustable suture surgery with respect to muscle slippage. METHODS: The primary treatment group consisted of 57 patients who underwent semiadjustable suture surgery on a total of 61 muscles that either had never previously undergone surgery or had undergone surgery and had not previously slipped postoperatively. Fifty-five were inferior rectus muscles and 6 were medial rectus muscles. An additional 7 patients had semiadjustable suture surgery on muscles that had slipped after prior surgery and were analyzed separately. The outcome evaluation was at least 6 months after surgery. RESULTS: None of the 57 patients in the primary treatment group demonstrated muscle slippage after semiadjustable suture surgery. One of the 7 patients who had history of prior muscle slippage also had slippage after semiadjustable suture surgery. CONCLUSION: The semiadjustable suture procedure appears to decrease the incidence of muscle slippage.

Adolescent↗
PubMed2005

Combined adjustable rectus muscle resection--recession for incomitant strabismus.

INTRODUCTION: We sought to report the results of combined adjustable suture resection and recession of a rectus extraocular muscle in a subset of patients who are asymptomatic in the primary position but diplopic in secondary functional gaze positions. METHODS: We undertook a retrospective chart review of 12 patients who underwent a surgical procedure consisting of combined resection and recession of the same rectus extraocular muscle on adjustable suture, the amount of recession being double the amount of resection. RESULTS: The amount of incomitance reduced from a preoperative mean of 11.6 prism diopters (PD) to a postoperative mean of 2.9 PD. All 4 rectus muscles underwent operation No significant change in the primary position alignment occurred. Diplopia was eliminated in 11 of the 12 patients postoperatively. CONCLUSION: The combined adjustable suture resection and recession operation is an effective and easy procedure for treatment of this subset of patients with incomitant strabismus.

Adolescent↗
PubMed2006

Increasing muscle strength as a treatment for strabismus: sustained release of insulin-like growth factor-1 in rabbit extraocular muscle.

PURPOSE: Currently, no drug treatment is available for strengthening underacting extraocular muscles (EOM) in strabismus. We showed previously that single injections of insulin-like growth factor (IGF-1) result in significant but short-term increases in muscle force generation. This study examined the effects of sustained release of IGF-1 on force generation in rabbit superior rectus muscles. METHODS: In adult rabbits, slow-release pellets containing IGF-1 were implanted on the global side of one superior rectus muscle. After 1 week, or 1, 2, 3, or 6 months, treated and control muscles were examined for force generation using an in vitro physiology apparatus. All muscles were prepared for histology and mean myofiber cross-sectional areas were determined. RESULTS: One and 3 months after pellet implantation, treated muscles generated significantly greater force than contralateral control muscles, whereas at 2 months, no significant difference was found. Force per cross-sectional area (mN/cm(2)) at 3 months also increased significantly in the treated muscles. Mean muscle cross-sectional area increased significantly after 1, 2, and 3 months of sustained exposure to IGF-1 compared with controls. After an additional 3 months without IGF-1 exposure, mean cross-sectional areas were significantly greater than controls but significantly reduced compared with areas at 1, 2, and 3 months. CONCLUSIONS: IGF-1 appears to be highly effective in increasing muscle force generation. Because slow release of IGF-1 results in sustained increases in EOM force generation, it may be a potentially useful alternative to surgical resection procedures because it avoids many of the potential long-term biomechanical hazards of resection surgery.

Animals↗
PubMed2006

The American Association for Pediatric Ophthalmology and Strabismus workforce distribution project.

PURPOSE: To describe data sources and functional utility of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) workforce database and associated map files. METHODS: Population data from the 2000 U.S. Census and current listings from the AAPOS and American Academy of Ophthalmology (AAO) databases were organized to demonstrate and analyze practitioner-to-population relationships for metropolitan statistical areas nationwide. An interactive map was developed to provide an intuitive graphical display of the data. RESULTS: A total of 749 active AAPOS members were distributed in 154 of 280 defined metropolitan statistical areas. Within these areas, a 0- to 20-year age subgroup varied from 17.8% to 42.6%, with an average of 30.4%. The AAPOS member-to-million-person ratio varied from 1.3 to 27, with higher numbers generally representing regions with population bases inadequately defined by Census Bureau statistical area definitions. Ratios for a majority of larger, better-defined areas ranged from 3 to 4 AAPOS members per million persons. Sizable areas with no AAPOS member presence were identified and tabulated. AAO members with a specified pediatric practice focus who were not AAPOS members were identified in 103 areas, possibly influencing patient choices and practitioner referrals for these regions. CONCLUSIONS: The AAPOS workforce database and related interactive map display practitioner and population data that may assist physicians and planners in targeting practice development and identifying potentially underserved areas.

Databases, Factual↗