Binocular vision & strabismus quarterly最新文献

Purpose: To investigate the long-term vision outcomes of amblyopia treatment in "successfully" compared with "unsuccessfully" treated patients.

Methods: Forty-two participants (n=42, mean age 14.8 years, range 10-25 years) were enrolled in the study. Individuals with strabismic or mixed (strabismic and anisometropic) amblyopia were examined at a mean of 6.6 years (range 1-18 years) after cessation of amblyopia treatment. Participants were classified as being "successfully" treated (Group 1) if visual acuity of 6/7.5 or better was achieved at cessation of treatment, or "unsuccessfully" treated (Group 2) if visual acuity of 6/9 or less was achieved at cessation of treatment. Visual acuity was analyzed by calculating an interocular score or difference in visual acuity between the amblyopic and non amblyopic normal (control) eye.

Results: A deterioration of visual acuity occurred in 62% of the participants in both Groups 1 and 2. The mean deterioration of visual acuity over time for either group was less than one LogMAR chart line and was not "statistically significant" by convention (F [1,39]=3.361, p=0.074). The outcomes achieved at cessation of treatment did not "statistically significantly" affect the mean deterioration that occurred over time (F [1,49]=0.031, p=0.860).

Conclusion: Visual acuity was relatively stable over a mean followup period of 6.6 years. The treatment outcome and the success of amblyopia treatment were found to be irrelevant to long term stability of visual acuity. These findings suggest that amblyopia treatment mostly results in a lasting improvement in visual acuity, and that both unsuccessfully and successfully treated individuals maintain their visual acuity improvement achieved during treatment.

Background and purpose: Since Kestenbaum and Anderson, several ophthalmologists have reported the results of different surgical procedures, for abnormal head posture in infantile nystagmus. In this study, we tried to evaluate the surgical results of Parks' original 5-6-7-8 mm modified Kestenbaum procedure and our own 6-7-6-7 mm modified Kestenbaum procedure, designed to reduce some of the problems encountered with other variations of these techniques.

Methods: Medical records of 92 patients, who had modified Kestenbaum surgery (5-6-7-8 mm or 6-7-6-7 mm) at The Yonsei Medical Center, from March 1991 to September 2001 with a follow-up period of more than 6 months, were reviewed retrospectively. We compared Parks' modified Kestenbaum surgery (5- 6-7-8 mm) performed on 51 patients with our own modified Kestenbaum surgery (6-7-6-7 mm) on 41 patients. Each procedure was done with graded augmentation according to the amount of the face turn and the null point in electro-oculography.

Results: In the follow-up of an average 33 months, 45 out of 51 patients (88.2%) who underwent Parks' modified procedures showed face turn less than 10 degrees. In the follow-up of an average 29 months, 36 out of 41 patients (87.8%) with 6-7-6-7 mm procedure had face turn less than 10 degrees.

Conclusions: We suggest that 6-7-6-7 mm modified Kestenbaum procedures with a graded augmentation may be a safe and efficient procedure to correct abnormal head posture in infantile nystagmus with a minimum decrease in ocular motility.

Objective: To introduce a variation of adjustable suture recession surgery of the inferior rectus muscle by adding a non- absorbable "safety stitch" to reduce post surgery overcorrection.

Methods: Eleven patients with vertical strabismus who needed inferior rectus recession were the subjects of this study. The vertical deviation was measured preoperatively, 24 hours after the adjustment, and after a minimum of a year followup. An adjustable suture technique through a limbal incision with a silicon sheet was used. We added a non-absorbable suture in the medial edge of the tendon of the inferior rectus muscle and fixed it at the scleral insertion of the muscle. This area of the inferior rectus tendon was exposed for the adjustment, which was performed 24-48 hours after the surgery. The safety suture was then fastened with a knot and 4-6 prism diopters (pd) of undercorrection in down gaze was intentionally left.

Results: The average preoperative vertical deviation was 17 prism diopters (pd) in primary position, and 21.6 pd in down gaze. Six of the eleven patients were adjusted postop' leaving an average residual vertical deviation of 2 pd in primary position and 4.7 pd in down gaze. After a year of followup, the average vertical deviation was 0.4 pd in primary position and 2 pd in down gaze. Ten of the eleven patients were considered to have "successful" primary surgery using this technique. The eleventh required a second operation for an undercorrection which resulted from inadequate original placement of the safety stitch.

Conclusions: The non-absorbable safety stitch technique provided satisfactory results, superior to previously reported techniques for postop' adjustable recession strabismus surgery of the inferior rectus muscle.

The National Guard has extensive capabilities that are impossible to attain in active duty units, largely because its citizen Soldiers bring their civilian expertise in addition to their military occupational specialties. While deploying to Afghanistan as the flight surgeon for a forward deployed Special Forces (SF) battalion, this Colorado Army National Guardsman also provided basic ophthalmology care in theater in the absence of an assigned ophthalmologist. The SF Battalion Preventive Medicine (PM) NCO was also an experienced eye technician in civilian life. Emergency eye surgery was provided for allied, coalition and host nationals in accordance with the Rules of Engagement. Elective eye surgery was an excellent method to build rapport and trust in keeping with the Special Forces "winning the hearts and minds" philosophy.

Background and purpose: To review and explain some of the characteristics of synergistic divergence and compare the surgical effect on each of those characteristics.

Methods of study: Three patients demonstrating findings characteristic of synergistic divergence, two bilateral and one unilateral, are reported. Surgery consisted of denervation extirpation of the lateral rectus muscle along with resection of the medial rectus muscle of the affected eye or supramaximal recession of the lateral rectus muscle and resection of the antagonist medial rectus muscle of the affected eye.

Results: The simultaneous abduction and the abnormal head posture responded well to surgery. The exotropia was reduced. The deficient adduction, the total absence of active abduction and the infraduction of the synkinetically abducting eye remained unchanged.

Conclusions: Synergistic divergence is a severe exotropic form of Duane's Syndrome where the feature of simultaneous abduction is the most striking. To date, no surgical procedure leads to satisfactory results on all the characteristics of synergistic divergence. Although some important features can be satisfactorily improved, some others do not respond to current surgical techniques.

Purpose: Some consumer digital cameras have short flash to lens distances (dimensions) ideal for photoscreening so we adopted them into an ongoing Alaska state wide vision screening program, the Alaska Blind Child Discovery (ABCD) Project.

Methods: Digital cameras with short flash-lens distance were employed by lay screeners trained by a DVD movie. Confirmatory eye examinations by AAPOS (American Association for Pediatric Ophthalmology and Strabismus) criteria were sought from eye doctors.

Results: 2900 children were screened in 62 clinics by 14 screeners. Of the 2900 screenings, 99% were readable with 6% refereed as positive for ocular pathology. The positive predictive value was estimated as greater than 80%. The per-screening image cost was less than $0.10 (10 cents) including cameras. Some screeners interpreted images similar to central reading center.

Conclusion: Pre-literate community eye and vision photoscreening can be both valid and cost effective.

Unlabelled: A prospective study was performed over a 10 year period on 25 children with infantile esotropia and neurological problems to answer this question. From November 1996 to March 2006 they were treated with injections of botulinum toxin (Botox) of both medial rectus extraocular muscles. Mean age was 26.4 months, (range 9-76 months) and mean initial angle was 35 prism diopters (PD)(range 20-60 PD).

Results: 18 patients (72%) remained orthotropic+/-10 PD at 29 months (range 6-59 months). Average number of injection treatments was 1.5 per patient. We compared our success rate data with those obtained with primary conventional strabismus surgical procedures in 2 previously published series. Treatment with botulinum toxin seemed to produce better results than one surgical series and at least equally similar results to the other one. Because there are, as well, so many other advantages to the injection procedure including superior safety and economy, we now use botulinum injections as our primary treatment in these patients.

Purpose: To enhance the safety and efficacy of surgical treatment of strabismus, we sought to measure and determine the ultrasound biomicroscopy (UBM) profile of scleral tunnels created with needles commonly used during strabismus surgery, to determine which needles are less likely to create the complication of scleral perforation.

Methods: Adult cadaver eyes were secured in a styrofoam head. Intraocular pressure was maintained between 15 and 21 mm Hg. Then S14, S24, S28 and TG100 needles were used to create scleral tunnels simulating those created during routine strabismus surgery. Ten scleral tunnels were created with each needle type at 3 different sites on the globe, for a total of 120 passes. The thickness of the sclera and the maximum depth and length of each scleral tunnel were measured using UBM.

Results: The mean tunnel depth below the scleral surface (+/- SD) was 0.43 +/-0.11 mm, 0.37 +/-0.09, 0.40 +/-0.08 and 0.34 +/-0.07 mm, for the S14, S24, S28 and TG100 needles, respectively (P=0.002, One way ANOVA). For both the S14 and S28 needles, there was a "statistically significant" P 0.05) linear trend of an increase in the depth of the pass as the length of the pass increased (P=0.01 for the S14 and P=0.02 for the S28 {Pearson Correlation 2 tailed test}). A similar trend was found with the S24 needle but the trend was not "statistically significant" (P=0.35). No such trend was found with the TG100 needle.

Conclusions: Needle design had a definite impact on the characteristics of scleral tunnels created to simulate those made during strabismus surgery and may influence needle selection by the surgeon for different or various surgical circumstances, but the differences were not such as to predicate for or against the general use of any of these four needles for strabismus surgery.

Purpose: To evaluate amblyopic patients with scanning laser ophthalmoscope (SLO) microperimetry to determine whether SLO assessment and data might provide useful information in our understanding of amblyopia and determine its utility in the evaluation of amblyopic patients.

Methods: In this retrospective case series, selected for SLO testing case series, clinical data of forty-six patients with amblyopia were reviewed after completion of treatment for anisometropic or strabismic amblyopia. Ten ophthalmologically age-matched, normal patients served as controls. All patients were tested with the SLO, evaluating for the presence of macular scotomata. SLO findings were assessed within each group and between groups.

Results: A macular scotoma was found in the amblyopic eye of 25 of 26 anisometropic amblyopic patients and all 20 strabismic amblyopia patients. Twenty of 26 patients with anisometropic amblyopia had a relative scotoma in the non-amblyopic "normal" eye. All 20 patients with strabismic amblyopia also had a non-amblyopic "normal" contralateral eye scotoma. None of the normal control patients had a scotoma in either eye. Several ocular and binocular clinical features were correlated to scotoma findings within and between groups.

Conclusion: The SLO proved useful for the assessment of some features of amblyopia. A scotoma was identified not only in the amblyopic eye of all but one amblyopic patient, as expected, but also in almost all of the fellow non- amblyopic, presumed "normal" contralateral eyes, and in spite of treatment normalization of visual acuity and stereoacuity in several cases. Thus, the ocular and binocular pathological effects of unilaterally functional amblyopia are not limited to the amblyopic eye but may also be seen, to a sub-clinical degree, by SLO microperimetry in the supposedly normal contralateral eye as well as in the apparently successfully treated previously amblyopic eye.