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

Purpose: Severe paretic and restrictive strabismus presents a challenging surgical problem. Despite aggressive, and often multiple, surgical attempts, patients can have recurrence of large angle binocular misalignments. In this paper, we present a series of patients who underwent apically-based orbital bone periosteal flap fixation of the globe in cases of restrictive strabismus due to isolated third-nerve and sixth-nerve palsies, multiple cranial nerve palsies, and severe ocular fibrosis syndrome.

Methods: We performed a retrospective study at our institution of patients who underwent a periosteal flap fixation. In all cases presented, the creation of the periosteal flap was performed by an orbital surgeon, and the strabismus surgery and follow-up data points were performed and collected by a strabologist.

Results: A total of 8 patients underwent a periosteal flap fixation of the globe. The mean age was 48 years old. Three patients had a third cranial nerve palsy, one patient had congenital fibrosis, one patient had sixth cranial nerve palsy, and three patients had multiple cranial nerve palsies. Five patients had a medial periosteal flap constructed, and 3 patients had a temporal periosteal flap. Seven of the 8 patients had stable postoperative strabometry (binocular misalignment) measurements. A single patient required an additional procedure secondary to postoperative drift (a mild recurrence of binocular misalignment).

Conclusions: The surgical correction of severe paretic and restrictive strabismus is complex and can present a formidable challenge. The use of an orbital bone-based periosteal fixation flap, at our institution, has shown satisfactory outcomes not only with regard to improved postoperative deviation, but also, in that most patients required only this single procedure, usually after several prior unsuccessful interventions by standard strabismus surgery procedures.

Purpose: To report a case of fat adherence complication syndrome after pterygium surgery, sufficiently severe enough to create a recurring significant extraocular motility problem and its ultimate novel and successful management.

Method: A 75 year old man was referred with an acquired large angle esotropia after pterygium surgery. Multiple previous strabismus surgeries to relieve the esotropia had already been performed but failed. Bilateral poor vision obviated complaints of diplopia but his binocular visual field was halved and his vision overall and his motility vision was handicapped by this limited ocular motility in his right eye. We therefore utilized homologous adjacent temporalis fascia transplantation for re-fixation of his frozen esotropic globe in primary position. Result of Surgery: Not only was the esotropia resolved but he also developed and regained some degree of abduction in this eye.

Conclusion: Homologous Temporalis fascia transplant can be used safely, for globe fixation in surgical treatment of severe restrictive strabismus.

Purpose: To report a case of acute comitant esotropia after monocular penetrating keratoplasty (PKP).

Case report: We present a 17 year old male patient with bilateral keratoconus who underwent penetrating keratoplasty in his right eye. He experienced diplopia after removal of the patch from the operated eye due to a new comitant esotropia in his left (unoperated) eye. Diplopia was controlled using prism glasses and then botulinum toxin injections until a penetrating keratoplasty was performed in his left eye and binocular vision and fusion returned.

Conclusion: Acute comitant esotropia may occur after loss of binocular vision and fusion due to brief ocular patching in a vulnerable patient. Fusion can be preserved with non-surgical methods until it can be permanently restored.

Purpose: Obtaining satisfactory binocular alignment in patients with Dissociated Horizontal Deviation (DHD) requires a proper diagnosis and a specific surgical strategy. Clinical characteristics, surgical treatment and the results obtained in 20 patients with DHD are reported with a mean of 35 months postsurgical follow up.

Patients and method: Retrospective record review of patients with DHD who underwent surgery between 2000 and 2007. Patient data were recorded, including age, sex, history of prior surgery, visual acuity, pre-operative angle with each eye fixing, Reversed Fixation Test (RFT) when available, type of operation performed, and final binocular alignment.

Results: Twenty patients were identified, mean age 11.7 years old, all of them with age less than 12 months at the time of strabismus onset. Ten of them had had prior surgery for congenital esotropia. Nine showed exotropia (XT), 9 esotropia (ET) and 2 had ET when fixing with OS and XT when fixing with OD. All of them also had an associated Dissociated Vertical Deviation (DVD). Seven patients had amblyopia in the non-dominant eye. Six patients underwent a single operation, 13 underwent 2 operations and 1 needed 3 surgeries to obtain satisfactory binocular alignment.

Conclusions: Patients with DHD also exhibit bilateral and, very often, asymmetric DVD. Therefore, a surgical plan for both the horizontal and vertical dissociation drift of the eyes is needed. Bilateral surgery is almost always necessary, even in cases with a strong fixation preference, in order to obtain satisfactory binocular alignment.

Background and purpose: A- and V-patterns are commonly encountered with cyclovertical muscle palsies. Inferior oblique (IO) muscle palsy produces and A-pattern caused mainly by the decreasing abducting action of the IO in upgaze and an increasing abduction action of the superior oblique in downgaze. V-pattern association with an IO palsy has not been, to our knowledge, reported before. The purpose of our paper is to report on a patient iwth IO palsy and a paradoxical V-pattern and explain the proposed pathophysiology behind the V-pattern.

Case report: We report a 67 year old female with a 3 year history of diplopia. She met the Bielschowsky/Parks three step test to identify an IO muscle palsy, and she showed all the usual criteria of an IO muscle palsy except for a paradoxical V-pattern.

Conclusion: Many forces affect patterns in cyclovertical muscle palsies. A V-pattern in IO palsy can be explained by the spread of comitance resulting in inhibitional innervational pseudo-palsy of the superior rectus muscle resulting in V-exotropia or in inhibitional palsy of the contralateral superior oblique muscle resulting in V-esotropia.

Background and purpose: This study was designed to compare heterophoria measurements obtained using the methods: prisms cover test (prism alternate cover test), von Graefe technique, Maddox rod test and modified Thorington test. Given the different methodological features of these tests, our working hypothesis was that these tests would not be interchangeable and repeatability would vary.

Methods: Horizontal deviation measurements were made at: far distance (six meters) and near distance (40 centimeters) on two occasions in 61 young subjects of mean age 19.7 years (range 18 -32 years), with essentially normal eyes and vision, who were not familiar with the methods used. Statistical repeatability and agreement were determined using the Bland and Altman method.

Results: Repeatability: No difference between the results of the various heterophoria tests was statistically significant. Coefficients of repeatability were always best when the tests were conducted at far, the cover test being the most repeatable. Agreement: Mean differences between absolute values ranged from 1.7 prism diopters to 5.1 prism diopters for measurements at far and from 2.1 prism diopters to 3.4 prism diopters at near.

Conclusions: The alternating prism cover test was the most repeatable test for measuring latent horizontal deviations. Among the subjective tests, the modified Thorington test was the most repeatable. The low level of agreement observed between the different tests makes their interchangeable use in clinical practice not recommended.

Anterior plagiocephaly is a craniofacial anomaly related to premature uni-lateral synostosis. We present a case of anterior plagiocephaly with vertical strabismus, overaction of the contralateral superior oblique muscle and an A pattern. A detailed ophthalmic examination and radio-imaging were done. The patient underwent strabismus surgery and resolution of the strabismus was obtained. Plagiocephaly has been reported to simulate ipsilateral superior oblique muscle paresis. We report a rare occurrence of contralateral superior oblique muscle overaction in an adult with anterior plagiocephaly.