[Results of inferior oblique muscle surgery in superior oblique paralysis]. / Les résultats de la chirurgie de l'oblique inférieur dans la paralysie de l'oblique supérieur.

The aim of this study was to evaluate the results of inferior oblique muscle recession in certain cases of superior oblique paralysis. Twenty-three patients with moderate hyperaction of the inferior oblique muscle, secondary to paralysis of the superior oblique muscle, in whom a recession of the ipsilateral inferior oblique was applied were enrolled in this study. These cases were selected among those with congenital superior oblique paralysis and infantile nontraumatic paralysis and those of unknown origin. Isolated recession of the inferior oblique muscle achieved a mean decrease in 8.69 +/- 2.05 D in hypertropia in the primary position. In 19 cases out of 23 (82.6%) who received isolated recession of the inferior oblique muscle, a vertical deviation equal to or less than 4 PD was obtained, showing the efficacy of this method in the surgical treatment of the cases with superior oblique paralysis and a moderate inferior oblique hyperaction.

Optical coherence tomography (OCT) and angiography in patients with angioid streaks.

PURPOSE: To investigate the retinal and choroidal features of angioid streak by fluorescein angiography (FA), indocyanine green angiography (ICG-A) and optical coherence tomography (OCT). METHODS: We analysed 46 eyes of 23 patients with angioid streaks examined at our retina section between March 1998 and June 2000. Their mean age was 42.8 years (26-61 years). After a routine ophthalmological examination, OCT and simultaneous fluorescein and indocyanine green angiography (FA/ICG-A) were done. Color fundus photographs were also taken. RESULTS: A peau d'orange appearance and angioid streaks were more numerous and apparent with ICG-A than FA. In two eyes (4.3%), some streaks that were well visualized on FA were not visible on ICG-A. Twenty eyes (43.5%) had macular complications and 26 (56.5%) were normal. Occult choroidal neovascularization (CNV) was diagnosed by ICG-A. Nine eyes had occult, and 11 had classic CNV Ruptures of Bruch's membrane were hypofluorescent in 20 (43.5%) and hyperfluorescent in 26 eyes (56.5%). Optic disc drusen were detected in both eyes of one patient (4.3%). Localized hyperreflectivity was thought to be due to calcium deposits. CONCLUSIONS: Angioid streaks were visualized more clearly and in larger numbers by ICG-A than FA. However, in some cases streaks that were funduscopically and fluorescein angiographically visible could not be seen by ICG-A. Occult CNV was detected by ICG-A. Some mottled areas were seen and more clearly visualized by ICG-A. Calcium deposits were observed as localized areas of hyperreflectivity on OCT. These findings indicate that fluorescein angiography, ICG-A and optical coherence tomography all provide supportive information for each other and can be used for either diagnosis or follow-up of those patients.

Optical coherence tomography and angiography in patients with angioid streaks.

PURPOSE: To investigate the retinal and choroidal features of angioid streak by fluorescein angiography (FA), indocyanine green anigography (ICG-A) and optical coherence tomography (OCT). METHODS: We analysed 46 eyes of 23 patients with angioid streaks examined at our retina section between March 1998 and June 2000. Their mean age was 42.8 years (26-61 years). After a routine ophthalmological examination, OCT and simultaneous fluorescein and indocyanine green angiography (FA/ICG-A) were done. Color fundus photographs were also taken. RESULTS: A peau dorange appearance and angioid streaks were more numerous and apparent with ICG-A than FA. In two eyes (4.3%), some streaks that were well visualized on FA were not visible on ICG-A. Twenty eyes (43.5%) had macular complications and 26 (56.5%) were normal. Occult choroidal neovascularization (CNV) was diagnosed by ICG-A. Nine eyes had occult, and 11 had classic CNV. Ruptures of Bruchs membrane were hypofluorescent in 20 (43.5%) and hyperfluorescent in 26 eyes (56.5%). Optic disc drusen were detected in both eyes of one patient (4.3%). Localized hyperreflectivity was thought to be due to calcium deposits. CONCLUSIONS: Angioid streaks were visualized more clearly and in larger numbers by ICG-A than FA. However, in some cases streaks that were funduscopically and fluorescein angiogrpahically visible could not be seen by ICG-A. Occult CNV was detected by ICG-A. Some mottled areas were seen and more clearly visualized by ICG-A. Calcium deposits were observed as localized areas of hyperreflectivity on OCT. These findings indicate that fluorescein angiography, ICG-A and optical coherence tomography all provide supportive information for each other and can be used for either diagnosis or follow-up of those patients. (Eur J Ophthalmol 2002; 12: 473-81).

[Value of MRI in the treatment of Grave's disease orbital myopathy]. / L'intérêt de l'IRM dans le traitement de la myopathie de l'orbitopathie dysthyroïdienne.

In order to evaluate the predictability of the results in the treatment of myopathy in cases with the clinical signs of muscle involvement, 177 extraocular muscles of 27 cases whose oedematous status was detected by MRI and who were given antiinflammatory treatment according to the data of this method, were studied. The nature of involvement was detected in respect with the signal intensity and thickness of each rectus muscle prior to the treatment and at the end of the sixth month following a three months' application of combined treatment of steroids and irradiation of 2000 rads. When the initial and final results were compared, the signal intensities of four involved recti showed significant decrease at the end of the treatment, as they were evaluated separately or together. Besides the thicknesses of these groups of involved recti which were evaluated separately showed significant decrease. The evaluation of the signal intensities by MRI is a way that enables noninvasive detection of the edema and prediction of the anti-inflammatory treatment's results of dysthyroid myopathy. Therefore a systematic follow up by MRI is recommended for the treatment choice in dysthyroid myopathy.

[Results of suture fixation in esotropia with non-accommodative far-near uncomitance]. / Les résultats de l'opération du fil dans les ésotropies avec incomitance loin-près non-accommodative.

PURPOSE: In esotropia, the dynamic component is the unique objective of suture fixation. The aim of this study was to assess outcome after the suture fixation used with or without other conventional methods and to determine the value of the anesthesia sign for evaluating the innervational factor of these esotropias. METHODS: Unilateral and bilateral posterior fixation sutures were applied in 54 cases exhibiting far-near incomitance between 10-20. The same procedure was applied in 14 cases with similar type of esotropia with incomitance greater than 20. RESULTS: A 100% success rate was achieved when suture fixation was used alone. When suture fixation was applied in combination with other conventional methods for cases with a static and a dynamic component the success rate was 86% (37/43 cases) in unilateral myopexy and 92% (12/13 cases) in bilateral myopexy. DISCUSSION: In cases with this type of esotropia, suture fixation, the only means of correcting a dynamic angle, gives good results as the component disclosing the apparent angle is well-documented. In addition, these findings emphasize the value of the general anesthesia sign to determine the innervational factor causing the dynamic angle.

[The angle under anesthesia and elongation of the lateral rectus muscle in primary esotropia]. / L'angle sous anesthésie et l'élongation du droit externe dans les ésotropies primitives.

PURPOSE: In a group of 34 patients with esotropia, the anesthetic sign was studied in order to decide on the selection of the eye that should be initially operated. It is based on the examination of the variation between the angle while the patient is awake and the angle under general anesthesia applied with a definite protocole. The operated eye was always the most convergent or the less divergent one under general anesthesia. METHOD: During the operation the elongation of the medial and lateral recti belonging to the operated eye were systematically measured by Rapp-Roth myometer and Péchereau ruler. RESULTS: In 58% of cases, the examination under general anesthesia revealed an equivalent deviation of the dominated and dominant eyes form the midline. In 19% of cases convergence was obvious in the dominant eye while it existed in the dominated eyes in 23% of cases. CONCLUSION: It is concluded that a significant relationship exists between the basic angle and the variation of the angle under general anesthesia as well as between the basic angle and the elongation of the lateral rectus. Besides, this study points out the absence of relationship between the angle under general anesthesia and the elongation of the lateral rectus as well as the elongation of the two recti.