Comparison between refractometer and retinoscopy in determining refractive errors in children--false doubt.

Early detection of a refractive error and its correction are extremely important for the prevention of amblyopia (poor vision). The golden standard in the detection of refractive errors is retinoscopy--a method where the pupils are dilated in order to exclude accomodation. This results in a more accurate measurement of a refractive error. Automatic computer refractometer is also in use. The study included 30 patients, 15 boys, 15 girls aged 4-16. The first examination was conducted with refractometer on narrow pupils. Retinoscopy, followed by another examination with refractometer was performed on pupils dilated with mydriatic drops administered 3 times. The results obtained with three methods were compared. They indicate that in narrow pupils the autorefractometer revealed an increased diopter value in nearsightedness (myopia), the minus overcorrection, whereas findings obtained with retinoscopy and autorefractometer in mydriasis cycloplegia, were much more accurate. The results were statistically processed, which confirmed the differences between obtained measurements. These findings are consistent with the results of studies conducted by other authors. Automatic refractometry on narrow pupils has proven to be a method for detection of refractive errors in children. However, the exact value of the refractive error is obtained only in mydriasis--with retinoscopy or an automatic refractometer on dilated pupils.

Endonasal endoscopic orbital decompression in patients with Graves' ophthalmopathy.

AIM: To present the results of endonasal endoscopic orbital decompression in patients with Graves' ophthalmopathy. METHODS: Endonasal endoscopic orbital decompression was performed in 32 orbits of 21 patients with Graves' ophthalmopathy. In 17 patients the surgery was performed because of active ophthalmopathy non-responsive to conservative treatment, and in 4 patients for esthetic reasons. Preoperative and postoperative examination included visual acuity, examination of the eyelids and cornea, ocular motility, cover testing, Hertel exophthalmometry, and applanation tonometry. RESULTS: Visual acuity improved from preoperative 0.81+/-0.28 (mean +/- standard deviation) to postoperative 0.92+/-0.21 (p=0.0032, Student t-test). Retraction of upper and lower eyelids, as well as exposure keratitis, was reduced after operation (p<0.001). Mean proptosis reduction in all orbits was 4.6+/-1.7 mm (p<0.001). An average reduction of intraocular pressure was 3.4+/-3.0 mmHg (p<0.001). New-onset diplopia developed in 8 patients. Diplopia persisted in 9 out of 11 patients who had preoperative diplopia. Two patients experienced postoperative relief of diplopia. Ocular motility was subsequently corrected by eye muscle surgery in 13 eyes, whereas prisms were used in other 5 manifestly strabic eyes. CONCLUSIONS: Endonasal endoscopic orbital decompression procedure improved visual acuity, decreased proptosis and intraocular pressure, and also had favorable cosmetic results in most patients. Post decompression diplopia and strabismus were successfully managed by either eye muscle surgery or application of prisms.