Journal of Binocular Vision and Ocular Motility最新文献

We describe an atypical presentation of aberrant regeneration of the 3^rd cranial nerve causing vision changes with ocular motility. Abnormal communication between axons destined for the medial rectus and those destined for muscles involved in the accommodative response resulted in simultaneous pupil constriction and myopic shift of approximately 2.5 diopters with adduction. While there have been several reports of this pupillary response (Czarnecki sign), no cases have documented the change in refraction from ciliary muscle involvement.

Duane retraction syndrome (DRS) is a complex congenital cranial dysinnervation disorder. The choice of surgical procedure in esotropic-DRS depends upon several factors that include: the amount of esotropia in the primary position, the presence and severity of palpebral fissure narrowing, globe retraction, presence of medial rectus muscle (MR) contracture, the likelihood of improving abduction, age of the patient, and the presence of binocularity and stereopsis. In the presence of MR contracture, MR recession is performed either alone (unilaterally or bilaterally) or in conjunction with Y splitting plus recession of the lateral rectus muscle (LR) for reducing globe retraction. MR recession, with or without adjustable sutures, may be simultaneously combined with partial thickness vertical rectus muscle transposition (VRT) or with superior rectus muscle transposition (SRT). We describe a novel combination of surgical procedures in the management of esotropic-DRS in two patients. In our first patient, following an initial MR recession combined with LR disinsertion and periosteal fixation (LRDAPF), a modified Nishida procedure was performed. In our second patient following a prior simultaneous MR recession and LR Y splitting with recession, we combined periosteal fixation of the LR with a modified Nishida procedure of the vertical rectus muscles.

Background and purpose: It has been reported there is a difference in the size of esodeviations when using letters compared to pictures or lights as a fixation target. In many clinics, small picture stickers are used as a target for preliterate or uncooperative children. In this study, experimental stickers with detailed pictures were compared to the Lang fixation cube and a monochromatic circle to assess their suitability as near fixation targets for the measurement of near deviations.

Patients and methods: Participants were 3-5 years of age and had an esodeviation. The near angle of deviation was measured using the three targets and compared to determine if treatment would be affected. Clinical significance is based on a difference of 5 prism diopters (PD) as this could potentially change the treatment plan.

Results: The results of the study show no clinically significant difference when comparing the three near targets. The experimental sticker induced the most accommodation, followed by the Lang fixation cube and then the red circle sticker.

Conclusion: Although none of the mean differences between the target comparisons reached the clinically significant threshold set, it should be considered that over one third of participants had a clinically significant difference in the esodeviation measurement at 33 cm when using the detailed picture sticker when compared to the red circle sticker.

For patients with a complete, chronic abducens nerve palsy and resulting abduction deficit, a transposition procedure is often the procedure of choice. One such transposition procedure involves transposing the superior rectus (SR) and inferior rectus (IR) laterally without disinserting or splitting either muscle. While effective, this procedure - like many transposition procedures - carries with it the risk of induced torsional or vertical misalignment. Here, we describe an adjustable variation of the above transposition procedure, one which potentially would allow for post-operative correction of induced vertical or torsional deviations.