Follow-up monitoring of accommodative esotropia.

PURPOSE: To ascertain an examination interval that will not increase the risk of untimely detection of decompensation of accommodative esotropia whether or not initial nonoperative treatment must be supplemented. METHODS: The records of 63 patients with accommodative esotropia examined at 3- to 6-month intervals were reviewed for the occurrence of decompensation, changes in refraction, and the need for increased correction of hyperopia or the addition of bifocals. RESULTS: Decompensation, which was not associated with substantial refractive changes toward or away from emmetropia, occurred in 11 patients. No instance of decompensation occurred in the first 12 months of observation. Although 7 of these decompensated patients were among the 18 (28.6%) requiring supplemental nonoperative treatment, their mean annual refractive change did not differ significantly from the 11 patients who did not decompensate. Eight (18.6%) of 43 patients first controlled earlier than age 48 months later decompensated; 3 (15.0%) of 20 patients with later onset reached this outcome. CONCLUSIONS: The monitoring of controlled accommodative esotropia at intervals of 9 to 12 months is adequate for most patients, at least over the first 2 years, with the exception of those requiring treatment for associated conditions such as amblyopia. Refractive error changes and the need for supplemental treatment after initial control are not prominently associated with decompensation. Age of onset of accommodative esotropia earlier or later than 48 months did not influence rapidity of decompensation.

Monitoring of controlled accommodative esotropia.

PURPOSE: To ascertain an examination interval that will not increase the risk of untimely detection of decompensation of accommodative esotropia whether or not initial nonoperative treatment must be supplemented. METHODS: The records of 63 patients with controlled accommodative esotropia examined at 3- to 6-month intervals were reviewed for age at first control, the occurrence of decompensation, initial refraction and subsequent changes, and the need for increased correction of hyperopia or the addition of bifocals. RESULTS: Decompensation occurred in 11 patients, not associated with substantial refractive changes toward or away from emmetropia. No instance of decompensation occurred in the first 12 months of observation, and only 11.5% occurred within 2 years. Although 7 of these decompensated patients were among the 18 (28.6%) requiring supplemental nonoperative treatment, their mean initial hyperopia and annual refractive change did not differ significantly from the 11 patients who did not decompensate. Eight (18.6%) of 43 patients who were first controlled earlier than age 48 months later decompensated; 3 (15.0%) of 20 patients with later onset reached this outcome. CONCLUSIONS: Monitoring controlled accommodative esotropia at intervals of 9 to 12 months is adequate for most patients, at least over the first 2 years, other than those requiring treatment for associated conditions such as amblyopia. Refractive error changes and the need for supplemental treatment after initial control are not prominently associated with decompensation. Age at onset of accommodative esotropia earlier or later than 48 months did not influence rapidity of decompensation.

GMS syndrome: a new dominant condition with goniodysgenesis, mental retardation, and short stature.

We describe a mother and daughter with a distinct phenotype that is different from previous reports. This is likely to constitute a new syndrome for which we propose the mnemonic GMS for G goniodysgenesis, M mental deficiency, and S short stature. The pattern of occurrence is compatible with either autosomal dominant or X-linked inheritance.

The accommodative portion of mixed esotropia.

This study reports observations on the subsequent course of the accommodative component in 139 patients with mixed esotropia after surgery for the nonaccommodative portion of the deviation. An unexpected finding was the presence of a normal distance/near relationship at the time of operation in 69% of these patients. In 40 cases (29%), the accommodative component subsided during the 1st postoperative year. In the remaining patients, the occurrence rate of improvement at longer intervals was similar to that for patients with pure accommodative esotropia observed in prior studies. Persistence was associated with preoperative spherical equivalent hypermetropia of more than 3.00 diopters, but not with a history of strabismus in close relatives. Accommodative esotropia appears to behave the same in pure and in mixed forms.

Construction and test of phase zone plates for x-ray microscopy.

We report the construction and test of an x-ray phase zone plate with 0.1-microm imaging resolution and >14% diffraction efficiency. The zone plate served as the focusing optic in a scanning microscope that operated in the water window, 2.5 nm < lambda < 4.5 nm, and therefore is optimally suited for imaging wet biological specimens. We enhanced the efficiency of the zone plate by using germanium for the absorbing zones, so that some of the incident radiation is transmitted with the correct phase shift to interfere constructively at the focal spot. The zone plate was supported on a relatively transparent membrane, giving the microscope a high absolute throughput.

Soft-x-ray projection lithography: printing of 0.2-microm features using a 20:1 reduction.

We demonstrate nearly diffraction-limited printing of 0.2-microm features, using soft x rays of approximately 36-nm wavelength. An open-stencil transmission mask with minimum features of 4 microm was imaged by a twentyfold-reduction Schwarzschild-type objective onto silicon wafers coated with various e-beam resists. Implications for soft-x-ray projection lithography are discussed.

Atomic-density-dependent losses in an optical trap.

We have observed that two-body collisions between cold sodium atoms confined within a magnetic-molasses optical trap lead to significant atomic-density-dependent trap losses. Such losses set an upper limit to the product of atomic density and confinement time that can be achieved in such a trap.

Recurrent esotropia.

Recurrent esotropia is characterized by repeated recurrence of the preoperative angle of strabismus after initial operative alignment. It occurred in 19 of approximately 3,000 patients operated on for esotropia with an onset of birth or in childhood during a 10-year period. Among the etiologic factors to be considered are progressive and under corrected hypermetropia, the nystagmus blockage syndrome, the blind spot syndrome, abnormal fusional movements, an unstable high AC/A ratio, and non-accommodative convergence excess. None of these factors played an exclusive role in our patients.

Persisting accommodative esotropia.

This report examines the persistence of many cases of accommodative esotropia well beyond the expected time of resolution (age 10 to 12 years) and the potential usefulness of any associated clinical features to predict timely or delayed disappearance. In a series of 202 patients, there was no discrete age of improvement and more than half persisted after age 10 years. The results were similar for both high and normal accommodative convergence/accommodation ratio cases. Initial hyperopia did not predict persistence; subsequent increases prior to age 7 years, and decreases thereafter, were different statistically but were clinically similar. Moreover, the occurrence of inferior oblique overaction and of dissociated vertical deviation, as well as a family history of strabismus, did not predict persistence or delayed improvement.

Clinical features of Duane's syndrome.

This report describes the clinical findings in 70 cases of Duane's retraction syndrome. There were 25 (36%) affected males and 45 (64%) females. Left eye preponderance (67%) was observed and seven (10%) were bilateral. Type 1 cases were the most common (73%), and bilateral cases often were of different types. The features studied were primary position deviation, face turn, anomalous vertical movements, divergence in midline vertical gaze, anisometropia, and amblyopia. Horizontal saccadic velocities in ten patients were confirmatory. The significance of head positions and distance/near alignment comparisons, and the role of case classification and saccadic velocity determination are discussed.