1/25. Unilateral congenital oculomotor nerve palsy, optic nerve hypoplasia and pituitary malformation: a preliminary report.A newborn male presented with complete external third nerve palsy of his right eye immediately at birth. Pediatric examination and MRI of the skull revealed no abnormalities. At the age of six weeks, strabismus surgery was performed to facilitate amblyopia treatment. The muscles appeared small and fibrotic. At the age of ten weeks, a brow suspension of the upper lid and a second strabismus surgery were performed. The amblyopia treatment and patching, applied for half of the waking hours over a period of six weeks, were unsuccessful. At the age of six months, a relative pallor of the right optic nerve head became evident. At the age of three years, at a new examination because of growth deficiency, a second MRI revealed defects involving the pituitary region. We concluded that extraocular muscle abnormality or oculomotor nerve palsy was present together with optic nerve dysplasia and pituitary gland malformation.- - - - - - - - - - ranking = 1keywords = strabismus (Clic here for more details about this article) |
2/25. Electronically measured compliance with occlusion therapy for amblyopia is related to visual acuity increase.PURPOSE: We set out to determine whether the children who have low compliance (measured electronically) with occlusion therapy for amblyopia are those with insufficient increase of visual acuity. methods: In 14 newly identified amblyopic children (mean age 4.3 /-1.9 years), compliance was measured electronically over a period of 1 week, 6 months after the start of occlusion therapy. compliance was measured with an Occlusion Dose Monitor (ODM). The measurements took place during planned domiciliary visits. The children were diagnosed with anisometropia (n=5), strabismus (n=4) and anisometropia and strabismus (n=5). compliance was expressed in percentages of the electronically registered time compared with the prescribed occlusion time. Satisfactory acuity increase following 6 months of occlusion therapy was defined on reaching any of the following criteria: acuity increase expressed as a ratio between acuity of the amblyopic eye and acuity of the good eye of more than 0.75, acuity of the amblyopic eye exceeding 0.5 as measured on the E-Chart or Landolt-C, or three LogMAR lines of increase in acuity. RESULTS: Measured compliance averaged 80% in the eight children who had a satisfactory acuity increase and 34% in the six children who had an unsatisfactory visual acuity increase. Children with low acuity increase had statistically significantly lower compliance (P=0.038). CONCLUSION: The general assumption among orthoptists, that compliance with occlusion therapy for amblyopia is low in children with insufficient acuity increase, has been validated by electronic, objective means.- - - - - - - - - - ranking = 1keywords = strabismus (Clic here for more details about this article) |
3/25. Could visual neglect induce amblyopia?oculomotor nerve disease is a common cause of diplopia. When strabismus is present, absence of diplopia has to induce the research of either uncovering of visual fields or monocular suppression, amblyopia or blindness. We describe the case of a 41-year-old woman presenting with right oculomotor paresis and left object-centred visual neglect due to a right fronto-parietal haemorrhage expanding to the right peri-mesencephalic cisterna caused by the rupture of a right middle cerebral artery aneurysm. She never complained of diplopia despite binocular vision and progressive recovery of strabismus, excluding uncovering of visual fields. Since all other causes were excluded in this case, we hypothesise that the absence of diplopia was due to the object-centred visual neglect. Partial internal right oculomotor paresis causes an ocular deviation in abduction; the image being perceived deviated contralaterally to the left. Thus, in our case, the neglect of the left image is equivalent to a right monocular functional blindness. However, bell cancellation test clearly worsened when assessed in left monocular vision confirming that eye patching can worsen attentional visual neglect. In conclusion, our case argues for the possibility of a functional monocular blindness induced by visual neglect. We think that in presence of strabismus, absence of diplopia should induce the search for hemispatial visual neglect when supratentorial lesions are suspected.- - - - - - - - - - ranking = 1.5keywords = strabismus (Clic here for more details about this article) |
4/25. Refractive laser surgery in children with coexisting medical and ocular pathology.PURPOSE: To report the visual, refractive, and functional outcomes of photorefractive keratectomy (PRK) and of laser-assisted subepithelial keratectomy in a group of children with significant refractive error and underlying medical conditions or ocular pathology who were noncompliant with traditional management. SETTING: Nonhospital surgical facility and a hospital clinic. methods: This case series comprised 5 individual cases of anisometropic amblyopia and/or high myopia. Underlying medical and ocular conditions were as follows: upper eyelid hemangioma with oblique myopic astigmatism, Pelizaeus-Merzbacher leukodystrophy with nystagmus, klippel-trenaunay-weber syndrome with glaucoma, incontinentia pigmenti with unilateral optic nerve atrophy, and goldenhar syndrome with unilateral optic nerve hypoplasia. photorefractive keratectomy or LASEK was performed in 6 eyes of 5 patients. Age range at the time of surgery was 1.0 to 7.0 years. All procedures were performed under general anesthesia. RESULTS: Best corrected visual acuity improved by 2 lines in 2 patients and 1 line in 2 patients by 6 months after surgery. Stereopsis and/or fusional status improved in 3 patients. amblyopia treatment compliance improved in 1 patient. Alignment improved without strabismus surgery in 2 cases. A functional vision survey demonstrated a positive effect on the ability of all 5 children to function in their environment. CONCLUSION: During the period of visual cortical plasticity, refractive surgery, by eliminating the refractive component of amblyopia and by promoting fusional ability, provides considerable improvement in children, even those with underlying medical conditions associated with ocular pathology.- - - - - - - - - - ranking = 0.5keywords = strabismus (Clic here for more details about this article) |
5/25. Fixation preference for the affected eye in patients with unilateral Duane syndrome.duane retraction syndrome is a congenital incomitant strabismus caused by dysinnervation of the medial and lateral rectus muscles. patients with unilateral Duane syndrome (80-90% of cases) who exhibit a fixation preference tend to prefer the unaffected eye. We describe 8 patients with unilateral Duane syndrome who prefer the affected eye. The most frequent associated ophthalmic finding was decreased vision in the unaffected eye from anisometropia and/or amblyopia. An additional associated finding was decompensated intermittent exotropia in 2 patients.- - - - - - - - - - ranking = 0.5keywords = strabismus (Clic here for more details about this article) |
6/25. diagnosis and management of accommodative esotropia.BACKGROUND: Accommodative esotropia is the most common form of childhood strabismus presenting to optometric practice. Functional and cosmetic outcomes are often excellent but depend on accurate diagnosis, urgent and correct initial management and careful follow-up. case reports: We present several cases that highlight important aspects of the clinical care of accommodative esotropia. The first patient was mismanaged by undercorrection of hypermetropia, but was later accurately diagnosed to have accommodative esotropia and was subsequently managed successfully with full hypermetropic correction alone. The second patient had an accommodative esotropia with amblyopia. The third patient used a near addition to correct a residual near esotropia. CONCLUSIONS: The published evidence and these cases make several points regarding assessment, diagnosis and management of esotropia. Assessment must aim to reach a diagnosis based on aetiology, as the aetiology of esotropia has a significant impact on management decisions and prognosis.- - - - - - - - - - ranking = 0.5keywords = strabismus (Clic here for more details about this article) |
7/25. Unexpected good results after therapy for anisometropic amblyopia associated with unilateral peripapillary myelinated nerve fibers.Unilateral extensive myelination of the peripapillary nerve fibers may be associated with anisometropic myopia, strabismus, and reduced vision. Despite aggressive occlusion of the normal eye, visual results are often disappointing, presumably due to associated structural abnormalities in the macula which limit visual potential. We report two cases, a 21-month-old child and a 23-month-old child with unilateral peripapillary myelination, ipsilateral high myopia, and dense amblyopia. Despite an abnormal macular reflex in each child, vision improved to 20/30 in one child and 20/50 in the other child after occlusion therapy. Visual results in these patients suggest that aggressive amblyopia therapy should be considered in patients with anisometropic amblyopia associated with extensive myelination continuous with the optic nerve. Not all patients with unilateral peripapillary myelinated nerve fibers, an abnormal macula, and myopia will have refractory amblyopia.- - - - - - - - - - ranking = 0.5keywords = strabismus (Clic here for more details about this article) |
8/25. True transposition procedures.Three patients with large-angle strabismus and irreversible amblyopia in a previously-operated eye underwent a true transposition procedure in which a segment of resected extraocular muscle was used to lengthen its antagonist. Postoperative results were satisfactory and stable during follow-up of 9 to 14 months. Four prism diopters of deviation were corrected per millimeter of "alteration" (mm resection plus mm lengthening plus mm recession minus mm advancement). True transposition procedures can permit surgeons to capture large strabismus deviations with two-muscle surgery on one eye, appear safe and predictable, and offer an option in those patients who refuse adjustable suture techniques.- - - - - - - - - - ranking = 1keywords = strabismus (Clic here for more details about this article) |
9/25. Good visual outcome after endophthalmitis in an eye previously treated successfully for amblyopia.A child with an extensive periorbital hemangioma developed an endophthalmitis caused by staphylococcus aureus after her second strabismus surgical procedure. Treatment with vitrectomy and intraocular antibiotics and steroid resulted in preservation of her eye. Despite previous successful treatment for amblyopia in that eye, her visual acuity improved from hand motion during the acute episode of endophthalmitis to 20/40 -2.- - - - - - - - - - ranking = 0.5keywords = strabismus (Clic here for more details about this article) |
10/25. Form vision deprivation amblyopia: further observations.Nine cases of esotropia occurring in deprivation amblyopia, where exotropia rather than esotropia is usually found, showed a refractive error of hypermetropia. This fact suggested that an accommodative factor is largely responsible for the development of esotropia. A- or V-pattern strabismus was encountered in a higher incidence in deprivation amblyopia than in ordinary strabismus. Pattern-reversal VEP showed more prominent abnormality than flash VEP did. Studies of the sensitive period of the visual system revealed that the sensitivity is likely to be low for a month or two after birth and increases with a peak around the 18th month of age, decreasing thereafter with a waning slope to the end of the 8th year of life.- - - - - - - - - - ranking = 1keywords = strabismus (Clic here for more details about this article) |
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