1/7. Refractive surgery for refractive errors which cause strabismus. A report of 8 cases.PURPOSE: While excimer laser refractive surgery is a well known procedure for correcting refractive errors, its use in adult patients with accommodative or partially accommodative esotropia who wish to remove their glasses, and those with high anisometropia and exotropia has not been extensively studied. We report our experience treating these two conditions with refractive surgery. methods: A retrospective review of the records of 8 adult patients with stable refractive error who underwent refractive surgery by the LASIK procedure. Three patients had accommodative esotropia, 3 had partially accommodative esotropia, and two patients had myopic anisometropia and exotropia. RESULTS: The LASIK refractive treatment corrected the strabismic deviation related to the hyperopia in the accommodative and partially accommodative esotropic patients. It also corrected the exotropia in the myopic anisometropic patients with exotropia. CONCLUSIONS: Refractive surgery is effective in treating accommodative and partially accommodative esotropia in adults and in cases of myopic anisometropia with exotropia.- - - - - - - - - - ranking = 1keywords = strabismus (Clic here for more details about this article) |
2/7. 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 = 0.5keywords = strabismus (Clic here for more details about this article) |
3/7. Binocular vision impairment after refractive surgery.PURPOSE: To illustrate the need for an accurate preoperative orthoptic examination to prevent postoperative changes in binocular vision. SETTING: Department of ophthalmology, University Hospital Antwerp, Edegem, belgium. methods: Five patients presenting major subjective complaints after refractive surgery were analyzed. RESULTS: In 1 patient, a latent N IV palsy decompensated after laser in situ keratomileusis (LASIK) in the more myopic eye to achieve monovision. A second patient, operated on for N IV palsy 10 years earlier, presented a recurrence of the palsy after bilateral LASIK for myopia. The third patient complained of discomfort in binocular vision caused by aggravation of a preexisting intermittent esotropia that worsened after LASIK for hyperopia. The fourth patient complained of diplopia after LASIK in the highly anisometropic and exotropic eye. The fifth patient experienced a decrease in fusion and stereopsis at the time he became anisometropic after bilateral LASIK. CONCLUSIONS: Special care should be taken of patients who have a preoperative history of strabismus surgery, an overcorrection or undercorrection in 1 or both eyes, or anisometropia and of those who are unhappy with contact lenses. An orthoptic examination should be done with and without spectacle correction to detect underlying vertical phorias. Intended monovision should be examined initially using contact lenses.- - - - - - - - - - ranking = 0.25keywords = strabismus (Clic here for more details about this article) |
4/7. 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 = 0.25keywords = strabismus (Clic here for more details about this article) |
5/7. 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 = 0.25keywords = strabismus (Clic here for more details about this article) |
6/7. Congenital nystagmus, anisomyopia, and hemimegalencephaly in the klippel-trenaunay-weber syndrome.klippel-trenaunay-weber syndrome is a rare phacomatosis of uncertain aetiology, variable expression, and disputed pathogenesis, whose cardinal signs are cutaneous angiomas, varicosities, tissue hypertrophy, and arteriovenous fistulae. The case reported herein is the first description of an unusual variant with limb and facial hemihypertrophy, congenital nystagmus, progressive ipsilateral anisomyopia, and strabismus. We review the ophthalmic findings and report the co-occurrence of hemimegalencephaly with congenital nystagmus and ipsilateral axial anisomyopia.- - - - - - - - - - ranking = 0.25keywords = strabismus (Clic here for more details about this article) |
7/7. 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 = 0.25keywords = strabismus (Clic here for more details about this article) |