Delayed adjustable sutures: a multicentred clinical review.

PURPOSE: To characterise the results of the largest patient series to date undergoing closed conjunctival delayed adjustable suture techniques. METHODS: A multicentre retrospective review of 440 operations (patients aged 10-91 years) by five surgeons at four centres were evaluated for surgical outcomes associated with the delayed adjustable suture technique. RESULTS: 26% (116 of 440) of all patients required postoperative manipulation, with individual surgeon rates ranging from 13% to 56%. The majority of these patients did not complain of diplopia in target gaze and/or had satisfactory cosmetic improvement as evaluated at the 1-3 months follow-up visit (84%). Transient complications included dellen, poor conjunctival appearance, filamentary keratitis, infection, granuloma, exposed suture and corneal abrasion. Serious complications were rare. CONCLUSIONS: This large multicentred series characterises the closed conjunctival delayed adjustable suture technique for the correction of strabismus. It may present some significant advantages to more traditional adjustable suture techniques.

Early reoperation after vertical rectus muscle surgery.

PURPOSE: Adjustable suture strabismus surgery has a success rate between 90% and 94%. In some patients, undesirable deviations are noted in the first week after surgery. In this article, we describe a method of reoperation in the first week of the initial repair in an outpatient clinical setting. METHODS: A retrospective review of clinical records from 1990 to 1998 identified 7 patients who underwent reoperation of the original surgical procedure in a clinic setting. All patients had vertical deviations that were overcorrected and had a reversal of their diplopia. RESULTS: Follow-up ranged from 3 months to 59 months. All patients were free of diplopia and were either orthophoric or had small phoric deviations. CONCLUSIONS: Proper identification of patients with strabismus as a result of overcorrected adjustable sutures and prompt reoperation in the first week after surgery are possible and prevent the need for repeat anesthesia in the operating suite.

Effect of bipolar cautery on tensile strength of 6-0 polyglactin 910 suture.

PURPOSE: To determine the effect of bipolar cautery on 6-0 polyglactin 910 suture. METHODS: Three groups of sutures were tested for maximum tensile strength. The first group (direct cautery) had bipolar cautery applied directly to the suture. The second group (scleral cautery) had bipolar cautery applied directly on top of the sclera, through which the suture was passed one-half scleral thickness. The third group (control) had no application of cautery to the suture. RESULTS: The mean tensile strength for the direct cautery sutures (n=8) was 553 g; for the scleral cautery sutures (n=7), 577 g; and for the control sutures (n=5), 553 g. There was no statistically significant difference in tensile strength between the three groups, with the analysis of variance yielding P=.56. CONCLUSION: Bipolar cautery causes little to no risk of reducing the tensile strength of 6-0 polyglactin 910 suture in the setting of strabismus surgery.

Morning glory syndrome in children. Association with endocrine and central nervous system anomalies.

OBJECTIVE: To identify morning glory syndrome, an uncommon optic disc anomaly. Generally, it is an isolated ocular abnormality; however, some cranial facial and neurologic associations have been reported. PATIENTS: We herein report two patients with morning glory syndrome and associated pituitary dwarfism. In one patient, the pituitary insufficiency was secondary to compression of the pituitary gland by a basal encephalocele; in the second patient, causative factors were not identified. CONCLUSIONS: Patients with morning glory syndrome should have a complete general physical examination and growth evaluation so that early recognition and treatment of the patient with pituitary dwarfism can occur.

Microspherophakia in association with the rhizomelic form of chondrodysplasia punctata.

Chondrodysplasia punctata is a multisystem disorder, primarily involving the musculoskeletal system, skin, and eyes. Children with the rhizomelic form of this syndrome have characteristic facies with a saddle-nose deformity, hypertelorism, and frontal bossing. The musculoskeletal changes include proximal limb shortening, flexion contractures, congenital hip dislocations, and the characteristic radiographic finding of epiphyseal stippling of the axial skeleton and long bones. The most common ocular findings are cataracts and optic atrophy. We describe herein the first reported case of microspherophakia in association with the rhizomelic form of chondrodysplasia punctata.

Phakomatous choristoma: clinical, histopathologic, and ultrastructural findings in a 4-month-old boy.

A case of phakomatous choristoma of the lower eyelid is described. A survey of previously reported cases reveals a characteristic and consistent clinical and morphologic picture. Universally the patient presents in infancy with a rather small, firm, rubbery nodule attached to the lower edge of the inferior tarsal plate. Always present in the nasal aspect of the lower lid, the tumor is easily palpable. Recognition of this clinical picture may allow the ophthalmologist to suspect the appropriate diagnosis, but the final diagnosis should be based on the recognition of characteristic histopathology.

Pupillary block glaucoma following pediatric cataract extraction.

We present a case of pupillary block glaucoma that developed after cataract extraction in a pediatric patient. To prevent pupillary block and secondary glaucoma after cataract surgery we recommend that all pediatric cataract patients be given a prophylactic peripheral iridectomy.

Simultaneous superior oblique tenotomy and inferior oblique recession in Brown's syndrome.

The technique and results of simultaneous superior oblique tenotomy and 14-mm inferior oblique recession for true Brown's syndrome are presented for 16 eyes of 13 patients. A good or excellent result was achieved in 15 of 16 eyes (94%). Reoperation for overcorrection was not necessary; however, repeat tenotomy was required in two cases. Inferior oblique underaction was present in 12 of 16 eyes (75%) in the early postoperative period; however, elevation in adduction improved over time. At most recent examination, 92% of eyes demonstrated greater than 25 degrees elevation in adduction. Underaction of the superior oblique occurred in 3 of 16 eyes (19%). A simultaneous superior oblique tenotomy and inferior oblique recession is recommended in all patients selected to undergo surgery for true Brown's syndrome to prevent reoperation for iatrogenic superior oblique palsy.

Delayed conjunctival closure in adjustable sutures.

We describe a technique for delayed conjunctival closure in adjustable strabismus surgery. It combines many of the advantages of the limbal and cul-de-sac approaches, while eliminating many of the disadvantages.

Management of superior oblique palsy after surgery for true Brown's syndrome.

Thirty patients requiring surgery for true Brown's syndrome were examined postoperatively. Follow-up ranged from three months to 20 years. Eight-five percent of patients demonstrated some degree of superior oblique palsy, with 54% having a decompensated condition and 30% requiring a second surgical procedure. Patients with marked preoperative restriction appear to be at increased risk for developing a decompensated superior oblique palsy postoperatively. Solutions to this problem are suggested: 1) perform tenotomy at insertion and preserve the adjacent intermuscular septum so a less crippling effect is seen; 2) combine tenotomy with inferior oblique weakening initially in those patients with marked preoperative restriction.