IgG4-related ophthalmic disease involving extraocular muscles: case series.

BACKGROUND: To elucidate the clinical features of strabismus associated with IgG4-related ophthalmic disease (IgG4-ROD). All of the four patients with IgG4-ROD showed marked enlargement of the extraocular muscles, however, two patients showed orthotropia with full ductions and versions. One patient showed a small angle of exotropia and hypertropia of less than 5 prism diopters. One remaining patient showed orthotropia, full ductions and versions despite marked enlargement of the extraocular muscles, then developed hypertropia up to 35 prism diopters with activation of inflammation, which promptly improved after treatment with oral steroids. CONCLUSIONS: IgG4-ROD usually shows normal ocular motility despite extraocular muscle enlargement, which is the key distinguishing feature from other orbital inflammatory diseases. Active flare-up with increased serum IgG4 levels may produce a large angle of eye deviation, but mostly respond well to steroid treatment.

Postnatal systemic inflammation and neuro-ophthalmologic dysfunctions in extremely low gestational age children.

AIM: Compared to infants born at term, children born very preterm are at increased risk of visual dysfunctions and neonatal systemic inflammation. Here, we explore whether these two propensities are related. METHODS: As part of the ELGAN study, the concentrations of 16 mediators of inflammation were measured in blood obtained on postnatal days 1, 7, 14, 21 and 28 from 1062 children born before the 28th week of gestation. Presence of visual field deficit, strabismus and/or impaired visual fixation was recorded at age two. The concentrations of each protein were divided into quartiles within gestational week categories. We calculated odds ratios with 99% confidence intervals for having each disorder comparing children with concentration in the top quartile of each protein to children whose concentration was in the lower quartiles on the corresponding day. Analyses were adjusted for gestational age and birth weight Z-score. RESULTS: Only one of 80 assessments (16 proteins on five different days) was significant for visual field deficit, and one for impaired fixation. No association was found between strabismus and any inflammatory mediator. CONCLUSION: None of the three neuro-ophthalmologic dysfunctions assessed at two years appears to be associated with systemic inflammation measured the first four postnatal weeks.

Serum gastrin and blood glucose levels during halothane-nitrous oxide anaesthesia and strabismus surgery in children.

The purpose of this study was to determine whether serum gastrin levels are increased by reflexogenic stimuli applied to the extrinsic muscles of the eye. Serum gastrin and blood glucose concentrations were measured in ten normal children aged between 5 and 12 yr during general anaesthesia with halothane and nitrous oxide and during strabismus surgery. Fasting basal concentrations of gastrin (33.6 +/- 14.8 pg.ml-1) and of glucose (4.43 +/- 0.72 mmol.L-1) were in the normal range of values for children. Intravenous atropine (0.01 mg.kg-1), general anaesthesia with halothane in nitrous oxide and oxygen by mask for three minutes, tracheal intubation, extraocular muscle stimulation and surgical stress did not cause any variation in the mean serum gastrin concentration. On the contrary, tracheal intubation and surgical stress increased blood glucose concentrations (P less than 0.05). There was no difference in the serum gastrin levels after extraocular muscle stimulation between children with positive or negative oculocardiac reflexes (44.5 +/- 16.7 pg.ml-1 vs 38 +/- 14.7 pg.ml-1, respectively). The incidence of vomiting predischarge was 60 per cent. Serum gastrin levels did not differ between children who vomited and children who did not (44.3 +/- 18.5 pg.ml-1 vs 47.1 +/- 16.9 pg.ml-1, respectively). Vomiting after strabismus surgery cannot be attributed to high gastrin serum levels. Consequently, it is unlikely that vomiting after strabismus surgery is linked to an "oculogastric reflex" with the vagus nerve as the efferent pathway.

[Absorption of adrenaline after local administration to the eye]. / Die Resorption von Adrenalin nach lokaler Applikation am Auge.

Twenty patients undergoing surgery for correction of strabismus under general anesthesia were randomly selected to receive conjunctival application of 100 microliters (20 micrograms) adrenaline in both eyes or in neither (controls). A further 20 patients undergoing cataract surgery with local anesthesia were randomly selected to receive 1 ml adrenaline 1:10 000 (100 micrograms) or 1 ml balanced salt solution (controls) in the anterior chamber. Adrenaline in plasma was measured in six time points within 15 min (correction of strabismus) or at seven within 30 min (cataract surgery). Plasma levels of adrenaline, mean arterial pressure, and heart rate were comparable in treatment groups and controls. No severe arrhythmias were observed. Neither conjunctival application of 20 micrograms adrenaline or instillation of 100 micrograms adrenaline into the anterior chamber increases adrenaline levels in plasma, and there is no reason to suspect cardiovascular interactions.

A matched comparison of four suxamethonium administration techniques in patients with strabismus.

Four methods of administering suxamethonium were composed in patients undergoing surgery for strabismus who were matched for sex, age, weight and height. Pre-treatment with tubocurarine afforded the best control of suxamethonium-induced sequelae. Serum potassium remained within normal limits suggesting that individuals with strabismus behave differently from those free of this defect.