Binocular vision & strabology quarterly, Simms-Romano's最新文献

Purpose: To determine which factors are important in the development of secondary exotropia and the incidence of secondary exotropia occurring after a retroequatorial myopexy of the medial rectus muscle with recession in the treatment for partially accommodative esotropia associated with convergence excess.

Methods: In this retrospective study, the patients that underwent retroequatorial myopexy on both medial rectus muscles with recessions for partially accommodative esotropia associated with convergence excess were included. The incidences and angles of secondary exotropia at near and distance fixation were evaluated and the risk factors for secondary exotropia were analyzed.

Results: Four hundred forty-eight patients had retroequatorial myopexy on both medial rectus muscles with recessions. Three hundred forty-nine of 448 patients maintained satisfactory near and distance binocular alignment at the final follow-up. Secondary exotropia occurred in 37 of these patients and residual esotropia occurred in 62 patients. There were no significant differences between the incidences and angles of secondary exotropia at near and distance fixation. The preoperative absence of binocularity was the only independent risk factor for developing secondary exotropia after a retroequatorial myopexy of medial rectus muscle with recession.

Conclusion: We determined that secondary exotropia was not a common result of retroequatorial myopexy of the medial rectus muscles with recession. We determined that the preoperative absence of binocularity was the only independent risk factor identified in this study.

A 67 year old woman presented with her left eye fixed in adduction and infraduction. She had previous complicated strabismus surgery 18 years ago with a report of intraoperative loss of left medial rectus (MR) muscle (not retrieved at the time of surgery). An Orbital MRI of the left eye showed reattachment of the MR muscle to the globe and an axially enlarged globe associated with inferior displacement of the lateral rectus and nasal displacement of the superior rectus muscles. In ultrasonography the axial lengths were 24.1 mm in the right and 29.9 mm in the left eye. She underwent staged surgery: The first stage was a recession of the left MR muscle and union procedure on the SR and LR muscles followed by a second adjustable suture procedure under topical anesthesia, of right MR recession, right LR resection and left IR recession. After 12 months her eyes were still binocularly aligned. Unilateral high myopia must be considered in progressive esotropia. Imaging and ultrasonography can demonstrate anatomical abnormality and muscle paths to confirm the definite diagnosis. Union procedure described by Yokoyama is an effective procedure in correcting this strabismus associated with high myopia.

Objective: To present a case of concurrent diagnoses, Retinitis Pigmentosa and Granular Corneal Dystrophy, discovered in one patient experiencing progressive vision loss.

Methods: In this case report we studied fundus photographs, anterior segment photographs, Goldman visual field, and electroretinography.

Results: Exam findings on presentation: A 58-year-old Korean female with bilateral crumb-like corneal stromal deposits, waxy pallor of the disc, attenuated vessels and bone spicules. Visual field deficit, ERG and clinical evaluation supports a final diagnosis of both Retinitis Pigmentosa and Granular Corneal Dystrophy.

Conclusion: The presentation of both Retinitis Pigmentosa and Granular Corneal Dystrophy is a rare combination of vision loss. While both conditions are autosomal dominant and thus not, per se, extremely rare, they have not been documented to both contribute to vision loss in one patient.

Medical Specialties such as Ophthalmology extend historically back to the beginning of recorded history. Before there was photography to record physical abnormalities of living creatures, there was art and artists who did the recording in their works. Fortunately, many such recordings have been preserved, usually in museums. They provide the graphic evidence of the same medical problems which our ancestors suffered and survived but which we still do but now understand and can ameliorate better. The purpose of this paper is to provide and study several more examples of these art works, to illuminate these historical aspects of medicine, ophthalmology and binocular vision and life.