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

Background and purpose: There are conflicting reports concerning the relationship between depth of suppression and level of amblyopia in strabismics. Little attention has been given to anisometropes. This study examines the density of suppression in anisometropic amblyopes, with or without microtropia, and investigates whether there is a relationship with level of amblyopia.

Methods: Patients with anisometropia (defined as a difference of 1D or 0.5 D cyl), binocular single vision and a difference in corrected visual acuity of at least 0.1 logMAR between eyes were recalled. The degree of amblyopia was expressed as the interocular difference using the Bailey-Lovie logMAR chart. Stereoacuity (Titmus test), binocular alignment and fixation were recorded. The depth of suppression was measured using the neutral density filter bar together with the Worth four dot test at 4.5m (subtending an angle of 0.5 degrees). Best spherical equivalent (BSE) was calculated to represent anisometropia.

Results: Thirteen participants aged 8.3 years to 12.1 years (mean 9.7 years) completed the study. No significant correlation was present (r=0.10, p=0.74) between the depth of suppression and degree of amblyopia. However, there was a correlation between depth of suppression and level of stereoacuity (r=0.59, p=0.03). Six participants had microtropia and showed stronger suppression (p=0.03) and worse stereoacuity (p=0.001) than the pure anisometropes.

Conclusions: No evidence was found of a relationship between density of suppression and amblyopia in this cohort of anisometropic amblyopes.

Objective: To present three clinical cases of diplopia secondary to conjunctival surgery (for tumor of caruncle and recurrent pterygium surgery).

Patients and methods: Clinical data of three patients with binocular diplopia and incomitant esotropia associated with compensatory torticollis and duction limitation are shown and discussed. In all cases, a complete ophthalmological examination was performed including ocular motility study, duction test and preoperative evaluation under general anesthesia.

Results: The forced duction test was positive in all cases, confirming the diagnosis of restrictive strabismus. Uneventful surgery was performed in all cases in which conjunctival adherences to eye orbit bones were eliminated and the involved extraocular muscle was isolated and freed. Furthermore, some additional treatments were applied to avoid recurrency (subconjunctival and topical corticosteroids, amniotic membrane and therapeutic contact lens). One case presented postoperatively a new conjunctival adherence in spite of such anti-recurrency treatment although with no significant motility alterations associated.

Conclusions: Conjunctival surgery can cause fibrosis and conjunctival adherences leading to restrictive strabismus. The surgical procedure for solving this problem must be performed with special care to avoid complications and recurrencies. The use of antimetabolites or amniotic membrane seems to be recommendable to ensure a satisfactory postoperative outcome.

Background: Asymptomatic - or minimally so, eye conditions like uveitis, iritis, and glaucoma are silent stealthily blinding diseases, especially when present in children. The iritis that accompanies Juvenile Idiopathic or Rheumatoid Arthritis (JIA or JRA) is characteristically asymptomatic. Children with these must be examined regularly and routinely(see Reference 1 and Table) on an opthalmologic biomicroscopic slit lamp for the microscopic cells (and aqueous flare) which occurr in the anterior chamber of the eye, signaling the presence of iritis, and an immediate need for anti-inflammatory agents. Such an exam is also indicated when the so afflicted develop most any symptoms of a new or recurrent eye problem. Slit lamp iritis determination remains challenging. It virtually requires a major, not portable, table mounted and expensive biomicroscope. And the examiner designated in schedules (1) is a trained ophthalmolgist,, an "Eye M.D.". Both. There are times and places throughout the world where and when a slit lamp may be available but there is no Eye MD (or qualified ophthalmic technician or assistant) available in a timely manner to timely examine for iritis when such is needed as noted. However, there are theoretical advantages if a parent could detect iritis in their J I A child if a slit lamp were available, if they had been trained to use it and recognize iritis cells and flare.

Methods: A portable model of varying iritis severity was developed. Parents of JIA patients were instructed on slit lamp use and then attempted to match unknown models of iritis severity with known training models of varying concentrations of cells and flare.

Results: Twelve parents ranked the 5 unknowns with an average summed deviation from expected of 2.2 +/-2 grade levels (out of 12). This was a good and useful degree of training.

Conclusion: We were able to teach lay adults to match a model of iritis severity on a slit lamp. We would suggest that where needed, they could provide urgent and more convenient and faster diagnosis and treatment of recurrent iritis and also augment recommended scheduled Eye MD screening for iritis in JIA patients providing an effectively higher level of care, quality of life, and reduction in loss of vision for JIA victims at lower cost and greater facility for the patients, their caregivers and society as a whole.

The History of Medicine and Medical Specialties such as Ophthalmology, and the Subspecialty of Strabology extend 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, such as the Louvre, in Paris, France. They provide the graphic evidence of the same medical problems which our ancestors suffered and survived which we still do but now understand and can ameliorate better. The purpose of this paper is to provide several examples of these art works, to illuminate these historical aspects of medicine.

A 26- year-old woman who had a left head tilt since childhood was undergoing left inferior rectus resection to correct her left inferior rectus paresis. During the surgery, when the inferior rectus was isolated and engaged with an eye muscle hook, the muscle tore (snapped) completely into two pieces, 8 mm posterior to insertion. Fortunately, we were able to find the proximal portion of the muscle and, after a 3 mm resection, of the distal yet attached 8 mm portion, the proximal and distal portions were sutured together with a non-absorbable suture. After nine months followup there was significant diplopia, and the preoperative left head tilt and left hypertropia remained, so a left inferior rectus re-resection was done. At the end of 18 months followup after the second procedure there was no binocular deviation (strabismus) in primary position nor in any other gaze positions, but there was a mild ocular motility infraduction deficit present on left and down gaze.