Reversal of unilateral medial rectus recession and lateral rectus resection for the correction of consecutive exotropia.

BACKGROUND/AIMS: To evaluate the effectiveness and dose-effect relationship of unilateral medial rectus advancement to the original insertion and lateral rectus recession in the surgical management of consecutive exotropia. PATIENTS/METHODS: The charts of 62 patients operated on for consecutive exotropia in a single-surgeon paediatric ophthalmology practice with a minimum follow-up time of 6 weeks were reviewed. RESULTS: Fifty-two patients were managed with unilateral surgery involving medial rectus advancement and lateral rectus recession. The medial rectus was advanced to the original insertion, and the lateral rectus was recessed by the amount of millimetres it had originally been resected for patients with precise records on previous surgery (within one millimetre of the above). The mean age at surgery for exotropia was 12.86 years. The mean postoperative follow-up time was 2.5 years. The mean preoperative distance exodeviation was 33.4 prism dioptres (PD), and the mean reduction in the angle of strabismus was 33.5 PD. A successful surgical outcome, defined as ocular alignment within 10 PD of orthophoria, was obtained in 41 patients (78.8%) at final follow-up. The mean dose-effect relationship between the reduction in the angle of deviation and the sum of millimetres of the reoperation was 2.9 PD/mm. It varied widely among patients and was strongly correlated with the amount of preoperative exodeviation, that is the patients tended to respond more per millimetre of surgical intervention the greater the preoperative exodeviation. CONCLUSION: The standard reversal of unilateral medial rectus recession and lateral rectus resection is a simple and effective means for correcting secondary exotropia. The dose-effect relationship varied widely among patients and tended to correlate with the amount of preoperative exodeviation.

The prognostic value of visual evoked response latency in the treatment of amblyopia caused by strabismus.

Visual evoked response alterations and especially P100 latency were studied in 60 patents with amblyopia caused by strabismus. Patients were divided in two groups according to the mode of fixation of the strabismic eye. Group A included patients with eccentric fixation, and group B, patients with central fixation of the strabismic eye. In all cases visual evoked responses were recorded before and after a 6-month period during which the patients had full-time occlusion of the sound eye. In cases with eccentric fixation of the strabismic eye, P100 latency was more abnormal than in cases with central fixation. In cases where latencies are clearly abnormal before treatment, the prognosis is poor and the results after occlusion of the sound eye are unstable. In contrast, in the cases with normal or nearly normal visual evoked response latencies, the prognosis is better, and these eyes show satisfactory improvement of visual acuity.

Treatment of inferior oblique muscle overaction with myectomy or with anterior transposition.

This paper presents a comparative study of the effectiveness of myectomy and anterior transposition in the treatment of inferior oblique muscle overaction. We operated 160 patients with overaction of the inferior oblique muscle. Eighty patients (148 eyes) were operated by myectomy at the insertion and 80 patients (151 eyes) by anterior transposition of the insertion of the inferior oblique near the temporal side of the insertion of the inferior rectus muscle. Comparison of the two methods, using the chi-squared test, showed that: 1) both surgical procedures were equally effective (chi 2 = 0.26) for correcting overaction of the inferior oblique muscle and V-phenomenon; 2) weakening of the inferior oblique muscle of both eyes was almost always required (in 115 out of 116 cases) in cases with V-phenomenon and often (24 out of 44 cases) in cases of congenital paresis of the superior oblique muscle. We conclude that both procedures are equally effective and equally easy to perform.

[The macula in Adamantiades-Behçet disease]. / La macula dans le syndrome d'Adamantiades-Behçet.

Adamantiades-Behçet disease is a well known clinical entity in the Mediterranean area. Signs and complications in these patients, arising from the macular area, are often overlooked for a prolonged period of time, because they are masked by the inflammatory signs of the anterior segment and/or the vitreous. Although blindness, in most cases, is the result of the optic disc atrophy, the macular alterations--as a sequelae of inflammation--are responsible for the low visual acuity. The authors in a retrospective clinical study of the last 100 consecutive cases of A-B disease, studied these macular alterations in detail. Their findings are also described in detail. Therapeutic modalities center around treatment with steroids, Cyclosporine A, and argon laser application. The results obtained from a long follow-up period are discussed.

Glycose tolerance curve, HbA1 determination and cataract.

In a series of patients with advanced cataract and in another one of patients with incipient cataract, aged under 55 years, with no history of trauma or diabetes and a normal fasting blood sugar, the standard glycose tolerance test, as well as the HbA1 determination were performed. About 34% of the patients of the first group and 10% of the second group showed abnormalities of the tests. Asymptomatic diabetes was diagnosed in these patients and it is concluded that glycose intolerance is common in patients with advanced or incipient cataract, under 55 years of age, who show no glycosuria and have a normal fasting blood sugar on routine examination.

Some observations on the treatment of ischemic optic neuropathy.

We examined the efficacy of the treatment with steroids, vasodilators, and vitamins B1, B6, and B12 in 23 cases of anterior ischemic optic neuropathy treated at the Athens University Eye Clinic. We stress the necessity of an extended medication for 2 to 3 months, depending upon the improvement of visual acuity. Good results were achieved in 14 of the 23 patients.

Retinoblastoma: some aspects concerning diagnosis, heredity, and treatment.

The authors set forth their views on the early diagnosis, heredity, and therapeutic problems of retinoblastoma. They regard as imperative the frequent ophthalmological check-up of familial tumors and of tumors of sporadic occurence, notably when they are bilateral. The further problems posed by the surviving patients are discussed in detail in the light of follow-up examinations extended up to 15 years.

On the management of congenital cataract with Dardenne's equipment.

After a short review of the operative techniques applied for the extraction of congenital cataract the authors describe the method of irrigation-aspiration of the lens material by means of the Dardenne equipment. Following an analysis of the results obtained with this procedure in a number of patients operated on at the Eye Clinic at Athens University, they discuss the advantages and shortcomings of the method, insisting in particular on: the importance of a complete removal of the lens debris; the careful scraping of the posterior lens capsule, and the necessity of an intensive postoperative anti-inflammatory therapy, especially in cases of congenital cataract due to rubella.

The necessary resection of the levator muscle of the upper eyelid in the operation for congenital blepharoptosis.

The authors comment on the excellent postoperative results obtained in 22 eyes operated on according to the Blaskovics method for congenital blepharoptosis. They discuss the length of the resected part of the levator muscle of the upper lid, the length depending in each case on the degree of the ptosis and on the functional ability of the levator muscle. They arrive at the conclusion that the shortening of the levator muscle must be considerably greater than heretofore advocated by the classical view.

Some observations concerning expulsive hemorrhage.

The authors describe the occurrence of expulsive hemorrhage in 12 patients out of a total of 23,985 intraocular surgical operations (0.05%). As principal etiological factors they regard increased intraocular pressure in combination with coexisting hypertension and vascular sclerosis. Attention is drawn to the manifestation of the complication during the last years under the mild form of subchoroidal hemorrhage as a result of the use of osmotically acting drugs. In 9 cases the eyeball was salvaged.

Family distribution of concomitant squint in Greece.

From a study of a large number of brothers and sisters suffering from concomitant squint, the following data were obtained: (1) 42-9% of the patients showed congenital strabismus. (2) In 96-5% of the sibs strabismus was of the same type. (3) The presence of a significant refractive error occurred in 82-8% of the patients. (4) In all twins strabismus appeared at the same age in both twins, and the squint and the refractive error were of the same type. (5) The distance of the patients' homes from Athens had no effect on either (a) the time intervening between the onset of squint and the first visit to the eye specialist, or (b) the effectiveness of treatment.

[Some observations on the use of cyclocryopexy in the treatment of various forms of glaucoma (author's transl)]. / Einige Bemerkungen zur Anwendung der Zyklokryopexie in der Behandlung der verschiedenen Glaukomformen

Cyclocryopexy constitutes a method for the therapy of absolute or hemorrhagic painful glaucoma. The authors describe its technique, its indications and the postoperative results obtained in 38 patients, from which they make appropriate conclusions.

Data concerning colour vision deficiencies amongst 29,985 young Greeks.

In this survey, 29,985 young Greek employees were screened by the Ishihara plates and if necessary by further more detailed methods (including anomaloscope). The examination of 21,231 young males revealed 212 (1.00%) protanopes, 241 (1.14%) deuteranopes, 254 (1.20%) protanomalous, 978 (4.61%) deuteranomalous and 2 with monochromatic vision. In total, 1,678 males (7.95%) had a colour vision disturbance. The examination of 8,754 young females revealed 1 (0.01%) protanope, 2 (0.02%) deuteranope, 3 (0.03%) protanomalous and 31 (0.35%) deuteranomalous; no case of monochromatic vision in females was detected. In total, only 37 (0.42%) females had a detectable colour vision disturbance with applied screening method. These results are discussed and compaired with the available bibliographic data.

Some clinical aspects concerning microtropia.

The present study is concerned with the specific nature and the multiformity of microtropia, which is characterized by unilateral convergent small angle (under 10delta) strabismus with amblyopia and abnormal retinal correspondence. Three types of microtropia may be distinguished: Type I: Showing a positive cover test, amblyopia and abnormal retinal correspondence. Type II: Showing in addition to the above, heterophoria. Type III: Showing a negative cover test, a positive 4delta base-out prism test, amblyopia due to anisometropia, eccentric fixation and harmonious abnormal retinal correspondence, where the angle of anomaly is equal to the angle to eccentricity. For the prevention of microtropia all children aged under 4 and irrespective of the presence of any symptoms should undergo an eye examination. At a more advanced age the diagnosis of this clinical entity is of importance chiefly from a prognostic point of view, because it permits us to avoid futile efforts at correcting visual acuity by means of covering up to sound eye.

[Some clinical aspects concerning diplopia after retinal detachment surgery with cryopexy and episcleral silastic sponge (author's transl)]. / Einige klinische Aspekte der Diplopie nach Operation von Netzhautablösung vermittels Kryopexie und episkleraler Silasticplombe

The aetiology of diplopia following retinal detachment surgery after the Lincoff-Custodis method is examined. Of 140 patients operated, 16 (i.e. 11.4%) developed diplopia. The authors believe that this diplopia is due to a fixation of the eyeball at the point of the silastic sponge placement. As responsible factors, which depend on the manner of sponge fixation and the size of the sponge, they regard: Alteration of the bulb curvature, shortening of the Tenon's capsule placed over the sponge, and changes in the conditions of muscular action.