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At least 901 records · Page 50Linked to original sources
PubMed1995

A novel conjunctival incision for horizontal strabismus surgery.

We present a randomised, controlled study of a new approach to conjunctival incision in horizontal strabismus surgery. A peritomy is performed from 2 to 10 o'clock inferiorly allowing free access to the horizontal recti from below. No limbal stay sutures are required and the conjunctiva is left unsutured on completion of surgery. Results of 13 patients are presented. Each patient is paired with a control on whom conventional surgery was performed. The pairs were matched for age and surgeon. Results show a decrease in the time taken for the procedure and decreased discomfort in the post-operative period. The external appearance of the operated eye and the incidence of complications over a 6 week period were the same for both techniques.

Child↗
PubMed1996

Factors influencing the successful outcome and response in strabismus surgery.

In this retrospective study based on 140 esotropic and 51 exotropic patients, the factors influencing successful outcome and response to strabismus surgery were investigated. Thirteen independent variables were chosen. The pre-operative deviation was found to be the only discriminant factor for early and late successful surgical outcomes in esotropic patients. For exotropic patients the visual acuity of the left eye was the discriminant factor for early successful surgical outcome. In esotropic patients the response to surgery increased with increasing amounts of pre-operative deviation. It was lower for patients with older age of onset and larger amounts of medial rectus recession. For exotropic patients the response to surgery was higher for larger pre-operative deviations. Eliminating possible sources of error when determining the pre-operative deviation will improve the predictability of the response to surgery and surgical outcome.

Age Factors↗
PubMed1998

Inferior oblique syndrome: an under-recognised complication of strabismus surgery.

PURPOSE: To show the predictive factors that would indicate the possibility of inferior oblique inclusion when considering surgery on a previously operated lateral rectus muscle. We also aim to highlight the importance of freeing any inferior oblique attachment to the lateral rectus muscle during either a resection or a recession procedure. METHODS: A retrospective review was undertaken of 39 patients who had previously had horizontal muscle surgery. Pre- and postoperative ocular position and rotations were compared. Using the hypothesis that a vertical element to the strabismus or a deficiency of vertical ocular rotation may result from inclusion of inferior oblique fibres during lateral rectus surgery, we compared the groups using the Fisher Exact two-tailed test. RESULTS: Eight of the 39 patients were identified as having inferior oblique inclusion. Six were found to have a vertical deviation in the primary position and 6 a deficiency of vertical rotation. CONCLUSION: A vertical deviation or a deficiency of vertical rotation are significant predictors of inferior oblique inclusion into the lateral rectus insertion. Re-operation to free the inferior oblique fibres often fails to reduce the vertical deviation, and hence there is a need for careful dissection of the inferior oblique during the primary surgery.

Humans↗
PubMed1998

Comparison of granisetron and droperidol in the prevention of vomiting after strabismus surgery or tonsillectomy in children.

This prospective, randomized, double-blinded study evaluated the antiemetic efficacy of granisetron and droperidol in 80 ASA physical status I children, aged 4-10 years, undergoing strabismus surgery or tonsillectomy with or without adenoidectomy. After anaesthetic induction, the patients received either granisetron (40 micrograms.kg-1, n = 40) or droperidol (50 micrograms.kg-1, n = 40) intravenously. The incidence of vomiting during the first 24h after anaesthesia was 15% and 38% after administering granisetron and droperidol, respectively (P = 0.02). The requirement for rescue antiemetic therapy for the treatment of two or more episodes of vomiting was 0% with granisetron and 18% with droperidol (P = 0.001). In conclusion, granisetron was superior to droperidol in reducing the incidence and frequency of postoperative vomiting in paediatric patients.

Adenoidectomy↗
PubMed1999

Propofol-nitrous oxide versus sevoflurane-nitrous oxide for strabismus surgery in children.

Vomiting is a common problem following strabismus surgery. We compared the effects of propofol-N2O and sevoflurane-N2O on the incidence of oculocardiac reflex and postoperative nausea and vomiting. Forty unpremedicated children, aged 3-15 years were randomly assigned to two groups of 20 patients. In group 1, anaesthesia was induced and maintained with propofol infusion (173 +/- 41 micrograms.kg-1.min-1). In group 2, anaesthesia was induced with N2O (66%) in O2 and incremental sevoflurane via face mask and maintained with sevoflurane. Both groups received 66% N2O in O2 throughout surgery. The overall incidence of vomiting and antiemetic requirement in the first 24 h was significantly higher in sevoflurane-N2O group than propofol-N2O group (P < 0.05). The propofol-N2O group had significantly more episodes of oculocardiac reflex than sevoflurane-N2O group (P < 0.05). Propofol-N2O anaesthesia results in a significantly lower incidence of postoperative vomiting, yet a significantly higher incidence of oculocardiac reflex.

Adolescent↗
PubMed2000

Analgesic efficacy of ketorolac 0.5% ophthalmic solution (Accular) in paediatric strabismus surgery.

This prospective double-blind study was designed to assess the analgesic efficacy of ketorolac 0.5% ophthalmic solution compared with placebo in 30 healthy children undergoing extraocular muscle recession for correction of strabismus. After paracetamol 20 mg.kg-1 preoperatively, a standard anaesthetic was given. There were no significant differences in Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and faces pain scale (FPS) scores, requirement for supplementary analgesia or in postoperative vomiting between the two groups over the following 24 h. This study did not demonstrate improved postoperative analgesia when topical ketorolac eye drops were given in addition to paracetamol. This observed lack of efficacy may reflect difficulties in the use of CHEOPS and FPS in this age group with this pain model.

Child↗
PubMed2001

A randomized controlled trial of the antiemetic effect of three doses of ondansetron after strabismus surgery in children.

METHODS: One hundred and thirty-one healthy children, aged 31-152 months, undergoing strabismus surgery under general anaesthesia, were randomly allocated to one of four groups: group A received 0.04 mg.kg-1 ( identical with 1 mg.m-2) of ondansetron, group B 0.1 mg.kg-1 ( identical with 2.5 mg.m-2), group C 0.2 mg.kg-1 ( identical with 5 mg.m-2) and group D placebo, given intravenously following induction of anaesthesia. Morphine 0.15 mg.kg-1 was given intravenously, intraoperatively, to provide postoperative analgesia. Hourly records of emetic episodes were made for 24 h. RESULTS: A considerably higher proportion of children suffered emesis in the placebo group compared to the active treatment groups taken together, during the first 8 h of postoperative care (76% vs. 45%, P=0.002). During the first 8 h, only 25% of those in treatment group C suffered emesis, the number-needed-to-treat was 3. There was a statistically significant decrease in the chance of vomiting with increasing dose of ondansetron (P=0.03). By 24 h, the difference in the rate of emesis was less marked but still statistically significant (90% vs. 69%, P=0.03). CONCLUSION: Overall, children given ondansetron had less than one-half the risk of vomiting compared to those given placebo (hazard ratio 0.46, 95% confidence interval 0.29-0.74). The mean number of emetic episodes declined from 2.73 in the placebo group to 1.92 in treatment group C. There was no difference in the incidence of side-effects between groups.

Antiemetics↗
PubMedDate not supplied

[Voluntary control of unilateral strabismus sursoadductorius].

BACKGROUND: Strabismus with unilateral elevation in adduction is an upward deviation of the adducting eye of unknown, not necessarily paretic origin. The term "old trochlear palsy" may be erroneous since the hypertropia is not necessarily larger in downward gaze and a causative lesion can usually not be identified. We describe here a marked voluntary influence on unilateral elevation in adduction, in situations that exclude binocular fusion. PATIENTS: Two patients with an elevation in adduction of the right eye and a positive head-tilt phenomenon, a 21-year-old and a 28-year-old man, were able to vary their vertical angle of squint at will. Even under artificial conditions that exclude binocular fusion (alternate cover test, dark-red glass test) could they change their right-over-left deviation, Patient 1 between 4 and 20 degrees and Patient 2 between 0 and 15 degrees. Under natural viewing conditions both patients had binocular vision with stereopsis that decompensated only when they looked to the left. CONCLUSIONS: We assume that our two patients had a "motor memory" that stores the muscle innervation for parallel eyes, i.e. the innervation suitable for binocular vision, and that the patients made use of or neglected this memory at will. In general, our observations suggest that a variable recourse to such a motor memory explains why, in patients with unilateral elevation in adduction, the angle of squint often changes. A voluntary access to this memory may, however, be exceptional.

Adult↗
PubMed1991

[Tenotomy of the superior oblique muscle in treatment of A-pattern strabismus and Brown syndrome].

The superior oblique tenotomy and tenectomy is an very effective and predictable surgical method in correcting the A-pattern in strabismus when overaction of one or both superior oblique muscles is present. In this series of 42 patients with an A-pattern an average correction of 86 to 91% was obtained regardless of the degree of the A-pattern. So we didn't observe any case that was converted from an A- to a serious V-pattern as obviously a less reduction is obtained in lesser degrees of A-pattern. In 11 cases of true but atypical Brown's-syndrome the tenotomy of the superior oblique muscle had a very beneficial effect on the limited movement of the affected eye and a co-existing abnormal head posture.

Child↗
PubMed1988

[Fixation disorders in children with strabismus, cerebral palsy and epilepsy].

Seventy-five handicapped children with a severe deficiency of the fixation reflex are discussed. Fixation is never foveolar; instead, unsteady peripheral wandering is typical. Such children show large wandering deviations of the eyes. Vision is severely impaired and strabismus is present. The clinical picture is quite unmistakable and immediately suggests an underlying cerebral palsy with epilepsy. The findings and the consequences are discussed.

Adolescent↗
PubMed1988

[Eye position and function following late surgical correction of consecutive strabismus following primary tenotomy].

Even in patients with consecutive strabismus who had a partial or total tenotomy 10 to 50 years ago, reoperation is worthwhile. In 73% of the author's cases the squint angle was reduced to between -5% degrees and +5 degrees postoperatively; adduction or abduction were improved or normalized in 66%, convergence in 20%. In 29% simultaneous vision on a normal or slightly abnormal basis was achieved. Following dissection of scars and adhesions the tonotomied muscle was advanced and in some cases resected. If the squint angle was large, the antagonist was also recessed. In addition to preoperative diagnosis, which included prolonged compensation with prisms, the indication was affected by intraoperative findings.

Adult↗
PubMed1984

[Refractive errors, amblyopia and strabismus in congenital ptosis].

Fifty-four consecutive surgical cases of congenital ptosis were carefully evaluated to determine the incidence of refractive errors, strabismus and amblyopia. Of these patients, 70% had a refractive error, 43% had an astigmatism of more than 1.0, 55% had anisometropia, 27.5% had concomitant squint and 50% amblyopia.

Amblyopia↗
PubMed1982

[Ketamine anesthesia in strabismus surgery--hormone and cardiovascular tests].

The effects of ketamine anesthesia on the sympathoadrenal and adrenocortical system, on plasma concentrations of somatotropine and insulin and the circulatory system were investigated in eight patients undergoing strabismus surgery. Therefore blood concentrations of adrenalin, noradrenalin, ACTH, cortisol, somatotropin and insulin as well as arterial blood pressure and heart rate were measured 30 min after premedication (I), 5 min after the initial injection of ketamine (II) and in steady state during the operation (III). Plasma adrenalin and noradrenalin levels were determined fluorimetrically by a modified trihydroxyindole technic; plasma cortisol, somatrotropin and insulin were determined by radioimmunoassay. All examined parameters--except insulin--showed significant changes after induced of anesthesia and during surgery compared to the respective pre-anesthetic values.

Adolescent↗
PubMed1981

[Binocular sensory defects in intermittent divergent strabismus].

Intermittent divergent strabismus represents an entity in terms of motoric characteristics rather than in its sensorial basis. Separate investigations were carried out in two clinics on 156 patients. The results were evaluated together, the authors discussing each case. Only in 27 cases was the condition cured. The main group comprised 78 patients with subnormal binocular vision based on facultative microexotropia and instable/normal correspondence. Basic microexotropia with obligate ARC was found in 51 cases, i.e., more often than expected. Testing the stereo threshold proved to an inadequate criterion for cure.

Adult↗
PubMed1980

[Abundant familial occurrence of strabismus amblyopia (author's transl)].

Report on a family of 14 in which the mother and her first four children, born out of wedlock and having different fathers, had healthy eyes and no ocular troubles. Her husband, the father of the eight younger children, presented with concomitant strabismus and amblyopia in the left eye. All his children squinted also, and all but one had amblyopia and poor fixation in the affected eye.

Adolescent↗
PubMed2001

A comparison of grating visual acuity, strabismus, and reoperation outcomes among children with aphakia and pseudophakia after unilateral cataract surgery during the first six months of life.

PURPOSE: The method of correcting aphakia after unilateral cataract extraction during infancy is controversial. Some authorities advocate correction with an intraocular lens (IOL) whereas others advocate correction with a contact lens (CL). We compared grating visual acuity, alignment, and reoperative outcomes in age-matched children treated with these 2 modalities at 5 clinical centers. METHODS: Twenty-five infants born in 1997 or 1998 with a dense unilateral congenital cataract who had cataract surgery coupled with (IOL group, n = 12) or without (CL group, n = 13) primary IOL implantation were enrolled in this study. All patients were prescribed half-time occlusion therapy. In July 1999, their grating visual acuities, ocular alignments, and reoperation rates were assessed. RESULTS: The mean grating visual acuity (LogMAR) for the affected eye was 0.70 +/- 0.32 for the IOL group and 0.87 +/- 0.31 for the CL group (P =.19). The mean interocular difference in grating visual acuity was 0.26 +/- 0.30 for the IOL group and 0.50 +/- 0.28 for the CL group (P =.048). The incidence of strabismus (>10 PD) was 75% in the IOL group compared with 92% in the CL group (P =.24). The incidence of reoperations was 83% in the IOL group compared with 23% in the CL group (P =.003). CONCLUSIONS: Our preliminary data suggest that correcting aphakia after unilateral congenital cataract surgery with primary IOL implantation results in an improved visual outcome but a higher rate of complications requiring reoperation. A randomized clinical trial, the Infant Aphakia Treatment Study, is planned to further study the optimal treatment for aphakia following unilateral cataract extraction during infancy.

Aphakia, Postcataract↗
PubMed2001

Vertical strabismus in monofixation syndrome.

PURPOSE: The manifest angle of the horizontal deviation in monofixation syndrome (MFS) has been reported to reach a maximum of 8 to 10 PD. Review of the literature, however, revealed no studies about the vertical deviation associated with MFS. The purpose of this study is to evaluate the range of the angle of the vertical deviation in MFS. METHODS: Forty patients who had MFS with vertical strabismus in the distance primary position were included in this study. All fulfilled the criteria for monofixation, fusing Worth 4 dots at near but suppressing at distance and/or having stereoacuity between 3000 and 60 seconds of arc by using Titmus stereotest and a horizontal deviation within 8 PD of orthophoria by simultaneous prism and cover test. Patients were divided into 3 groups: patients with hypertropia without any dissociated vertical deviation (DVD) (group I), patients with only DVD (group II), and patients with both hypertropia and DVD (group III). RESULTS: Eighteen patients (45.0%) had hypertropia only (group I), 15 (37.5%) had DVD only (group II), and 7 (17.5%) had both (group III). In groups I and III the angle of hypertropia by simultaneous prism and cover test was 2 to 6 PD (mean, 3.9 PD) and in group II and III the angle of DVD was 4 to 14 PD (mean, 7.5 PD) at distance. CONCLUSIONS: These results suggest that in MFS the angle of hypertropia can range up to a maximum of 6 PD. However, monofixation was observed in patients with a larger absolute angle of DVD (up to 14 PD), possibly due to an intermittent nature of the DVD.

Adolescent↗