Presumed congenital ocular toxoplasmosis in two successive siblings.

We present the cases of 2 consecutive siblings with bilateral macular lesions, for which there is strong clinical and laboratory evidence supporting the diagnosis of congenital ocular toxoplasmosis. These cases raise the possibility of maternal parasitemia during Toxoplasma gondii reinfection, leading to transmission to the fetus and congenital ocular toxoplasmosis despite prior immunity and lack of an immune disturbance in the mother.

Bilateral medial rectus recession in convergence excess esotropia, with and without distance orthophoria.

PURPOSE: To evaluate the effectivity and safety of bilateral medial rectus recession for the correction of acquired convergence excess esotropia, with and without distance orthophoria. METHODS: Thirty-five pediatric patients with acquired convergence excess esotropia were operated with bilateral medial rectus recessions based on the near angle measured through the distance correction. Preoperatively, in 26 patients, full hypermetropic correction did not fully correct the distance angle; these patients were operated for the residual angle for distance and near. In nine patients full hypermetropic correction produced distance orthophoria and these cases also had near orthophoria through a near add; these patients could have used bifocals, but surgery was chosen instead. RESULTS: Postoperatively, 19 of the 26 patients with distance esotropia (73%) and 6 of the 9 with distance orthophoria (66.6%) were successfully aligned. Consecutive exotropia developed in two patients (7.6%) in the distance esotropia group and one (11.1%) in the distance orthophoria group. CONCLUSIONS: These results suggest that bilateral recession of the medial recti based on the near deviation is effective in eliminating the near angle in convergence excess esotropia. In patients with distance orthophoria this operation can be used as an initial treatment instead of bifocals. Although the risk of consecutive exotropia was low in this series, a larger number of patients would determine its actual rate more accurately.

Ophthalmic dirofilariasis.

PURPOSE: To report a rare case of ophthalmic dirofilariasis in a 68-year-old man with sudden, intense pain and itching in the left eye. The nematode was located in the eye and recognized as Dirofilaria repens. METHODS: Slit-lamp examination disclosed a moving nematelminth under the bulbar conjunctiva of the left eye. The nematode was surgically removed. RESULTS: The nematelminth surgically removed from the subconjunctival space was identified as D repens on the basis of transverse sections and its macroscopic characteristics. CONCLUSION: It is important to identify the nematode as D repens, based on both its microscopic and macroscopic characteristics, to avoid treatment with anthelminthic agents. The surgical removal of the worm is the sole recommended treatment.

Coloboma of the optic disk associated with retinal vascular abnormalities.

PURPOSE: We studied a case of congenital optic disk pit and coloboma with associated malformations of the retinal vessels. METHODS: Slit-lamp biomicroscopy and fluorescein angiography were performed. RESULTS: Multiple retinal venous anastomoses associated with a congenital coloboma and pit of the optic disk were observed. The retinal vascular anomalies extended from the optic disk to the temporal periphery. CONCLUSIONS: We consider the coexistence of retinal venous anastomoses with optic disk coloboma and pit to be an extremely rare congenital retinal anomaly.

8 mm bimedial rectus recession in infantile esotropia of 80-90 prism dioptres.

Sixteen patients with large angle infantile esotropia with deviations of 80-90 prism dioptres were operated at the age of about 2 years. All patients underwent 8 mm bilateral medial rectus recessions. At the last follow up examination, 6 to 48 months postoperatively (average 16.3 months), successful horizontal alignment was achieved in 12 patients (75%). Four patients (25%) were undercorrected. Clinically significant limitation of adduction or convergence was not observed postoperatively in any of the patients. Consecutive exotropia was not encountered in this series but a longer follow up is probably needed in order to assess its delayed appearance. These results suggest that 8 mm recession of the medial recti is an effective procedure for the correction of large angle infantile esotropia of 80-90 prism dioptres and can be considered as an acceptable alternative to operations on three or four muscles.

[Diminution of myopia following operation of macular hole-induced retinal detachment]. / Abnahme der Myopie nach Operation makulalochbedingter Netzhautablösungen.

This paper presents an assessment of the diminution of myopia in 25 eyes after surgery according to the technique of G. P. Theodossiadis for retinal detachment due to a macular hole. The procedure consists in the stretching and fixation of a silicone sponge at the posterior pole and dispenses entirely with either cryocoagulation or light coagulation. The sponge is stretched and fixed to the sclera at both ends (12 and 6 o'clock), far from the posterior pole. The scleral protrusion thus obtained in the macular area leads to a considerable diminution of the high myopia usually present in such cases. The reduction of myopia is proportionate to the degree of protrusion of the scleral buckle, which in turn depends on the stretching of the sponge and on the amount of subretinal fluid released.

Modification of the Kestenbaum operation for correction of nystagmic torticollis and improvement of visual acuity with the use of convergence.

In five patients with congenital nystagmus and compensatory head turn we performed a modified Kestenbaum operation intended to correct the compensatory head turn and to improve visual acuity. All patients had nystagmus without strabismus and fully developed binocular function. The nystagmus decreased but did not cease completely during the lateral gaze, and the patients adopted compensatory head turn positions to improve their visual acuity. The near acuity was better than the distance and the head turn decreased on near fixation. In such cases the original Kestenbaum procedure transfers the neutral zone to the primary position and corrects the head turn, but does not improve the visual acuity because a considerable amount of nystagmus is still present. Our aim was to perform an asymmetric Kestenbaum operation with a greater amount of surgery to the eye that turns out and a lesser amount to the eye that turns in, thus creating a postoperative divergence of the eyes. The result of compensating for this divergence (through stimulation of the fusional reserve) blocks the residual nystagmus of the neutral zone and, consequently, improves visual acuity. The results obtained from performing this modified Kestenbaum operation in five patients were very satisfactory. The compensatory head turn was corrected in all patients and remained so during the follow-up period. In four cases, the postoperative visual acuity in the neutral zone was better than before. There was no improvement in one case.