1/73. Etiology and surgical management of horizontal pontine gaze palsy with ipsilateral esotropia.INTRODUCTION: An esotropia ipsilateral to a horizontal pontine gaze palsy has been infrequently reported. We discuss the etiology and review the surgical management of this ocular motility defect. methods: Four patients with radiographically documented dorsal pontine lesions and persistent horizontal gaze palsy with esotropia ipsilateral to the gaze palsy were treated. In each patient, the esotropia was present in attempted primary gaze, producing symptomatic diplopia. An anomalous face turn was required to attain single binocular vision. RESULTS: All 4 patients underwent surgical correction to alleviate the anomalous head position and diplopia. Bilateral, asymmetric surgery was required to achieve a long-term successful result. Single binocular vision in the primary position with elimination or marked improvement of the compensatory head posture was initially achieved in all 4 patients. One patient, who had not undergone asymmetric strabismus surgery to reconcile incomitance produced by the esotropia, rapidly developed a residual esotropia. CONCLUSIONS: Ophthalmologists should recognize that concurrent esotropia may occur in patients with horizontal pontine gaze palsy. Single binocular vision in the primary position, an expanded binocular visual field, and alleviation of a compensatory head position are achievable with strabismus surgery.- - - - - - - - - - ranking = 1keywords = horizontal (Clic here for more details about this article) |
2/73. Periodic alternating nystagmus in two children with a similar, unusual phenotype.The report describes two unrelated male children, aged 6 and 8 years, respectively, with congenital periodic alternating nystagmus, congenital strabismus, microcephaly with cortical and cerebellar hypoplasia, mental retardation, low stature, and bat ears. Karyotypes were normal. Neuropediatric and ophthalmologic examinations, radiologic imaging of the brain, and laboratory analyses were performed to exclude other causes of periodic alternating nystagmus, such as ataxia-telangiectasia, acquired disease of the caudal brainstem or the cerebellum, albinism, or loss of vision resulting from cataract or vitreous hemorrhage. The similar morphologic and clinical features of both patients raise the possibility that they have an identical syndrome.- - - - - - - - - - ranking = 62.122889026119keywords = nystagmus (Clic here for more details about this article) |
3/73. Spontaneous resolution of infantile esotropia.PURPOSE: To report the spontaneous resolution of infantile esotropia in 3 patients. methods: The clinical histories and the results of ophthalmologic examinations in 3 patients with infantile esotropia were reviewed and analyzed with reference to the literature. RESULTS: All 3 patients with infantile esotropia were diagnosed with 25 to 30 PD of esotropia before the age of 6 months. All of them had insignificant refractive errors. Against medical advice, they were not brought in for follow-up examinations. At the age of 34 months to 59 months, the esotropia of the patients had changed into exophoria, esophoria less than 4 PD, or orthophoria. All patients eventually showed dissociated vertical deviation and overaction of the inferior oblique muscles. Of the 2 cooperative patients, 1 consistently identified Titmus stereograms with 3000 seconds of arc and fused Worth 4 dots at near and at distance. The other patient could not identify stereo targets and suppressed one eye on Worth 4 testing at distance, though she showed no suppression at near. CONCLUSION: In these cases, infantile esotropia with a relatively small angle may spontaneously resolve without any treatment. However, all these patients showed poor stereoacuity, dissociated vertical deviation, and overaction of the inferior oblique muscles.- - - - - - - - - - ranking = 0.028510002195377keywords = vertical (Clic here for more details about this article) |
4/73. Treatment of A-pattern esotropia with marked mongoloid slanting palpebral fissures.BACKGROUND: The association of oblique palpebral fissures and A- or V-pattern has not been clarified. We report two cases of A-pattern esotropia with marked mongoloid slanting palpebral fissures associated with vertical displacement of the horizontal rectus muscle. CASES: Case 1 was a boy with prader-willi syndrome. He showed A-pattern esotropia with upward slanting palpebral fissures. Severe superior oblique muscle overaction was observed. Case 2 was a girl with meningocele. She also showed A-pattern esotropia with upward slanting palpebral fissures. OBSERVATIONS: In case 1, weakening surgery of the superior oblique muscles did not improve the A-pattern. Coronal images of computed tomography showed one-half-muscle-width upward displacement of both lateral rectus muscles. After downward transposition surgery of the lateral rectus muscles, the preoperative A-pattern of 25 prism diopters (PD) was successfully corrected to 10 PD. In case 2 also, upward displacement of both lateral rectus muscles was shown by computed tomography. The preoperative A-pattern of 26 PD was corrected to 4 PD postoperatively after upward transposition surgery of the medial rectus muscles. CONCLUSIONS: The vertical displacement of horizontal rectus muscles was considered the principal cause of A-pattern in these cases associated with marked mongoloid slanting palpebral fissures.- - - - - - - - - - ranking = 0.31422428790966keywords = horizontal, vertical (Clic here for more details about this article) |
5/73. Anterior segment ischemia after surgery on 2 vertical rectus muscles augmented with lateral fixation sutures.Anterior segment ischemia is a rare but potentially serious complication of strabismus surgery. Anterior ischemia typically occurs after surgery on 3 or 4 rectus muscles. Advanced age, dysthyroid ophthalmopathy, and a history of previous strabismus surgery are known risk factors for this complication. This report reviews the case of a healthy 50-year-old patient who developed anterior segment ischemia after surgery on 2 rectus muscles.- - - - - - - - - - ranking = 0.057020004390753keywords = vertical (Clic here for more details about this article) |
6/73. Acute comitant esotropia after cataract surgery.A 52-year-old woman developed comitant esotropia after cataract surgery. The ocular history was significant for accommodative esotropia; preoperatively, she manifested peripheral fusion with central suppression. Immediately postoperatively, the patient was diplopic with comitant esotropia and was treated with extraocular muscle surgery. The appearance of horizontal strabismus after cataract surgery in patients with a history of accommodative esotropia, especially those with subnormal binocularity, is a possible complication that should be discussed with the patient.- - - - - - - - - - ranking = 0.14285714285714keywords = horizontal (Clic here for more details about this article) |
7/73. Bilateral recession-resection surgery for convergent strabismus fixus associated with high myopia.The authors report two patients with more than 20 diopters of myopia, severely restricted abduction, and more than 90Delta of acquired esotropia. Marked axial elongation of the globes was present. Each underwent large bilateral medial rectus recessions and bilateral lateral rectus resections. The deviations were significantly reduced and abduction improved with combined horizontal recession-resection surgery on both eyes.- - - - - - - - - - ranking = 0.14285714285714keywords = horizontal (Clic here for more details about this article) |
8/73. Discordant pursuit asymmetry and esotropia in monozygous twins.PURPOSE: To report the relationship between infantile esotropia and asymmetry of monocular pursuit tracking. DESIGN: Observational family case series. methods: A twin pair discordant for infantile esotropia was confirmed by dna analysis to be monozygous at 99.95% probability. Digitally sampled electro-oculographic recordings of monocular horizontal pursuit eye movements were performed for the twins and their orthophoric father. RESULTS: Mean directional asymmetry for right and left eyes was 31% and 5% for the esotropic twin, 10% and 8% for the orthophoric twin, and 5% and 6% for the father. The asymmetry was statistically significant only for the deviating right eye of the esotropic twin (P = 0.0217). CONCLUSION: In this family, monocular pursuit asymmetry is probably not a heritable predisposition to infantile esotropia, but a consequence of early strabismus. Discordance of infantile esotropia and pursuit asymmetry in monozygous twins implicates environmental in addition to genetic causes.- - - - - - - - - - ranking = 0.14285714285714keywords = horizontal (Clic here for more details about this article) |
9/73. Divergence insufficiency and demyelinating disorder.PURPOSE: To describe a divergence insufficiency in a young woman. methods: Case report. RESULTS: A 38-year-old woman presented with a episode of homonymus horizontal diplopia at distance. She was orthophoric at near but had esotropia at distance. Neurological evaluation was normal but multiple demyelinating lesions were shown in the magnetic resonance scan, with increased intrathecal Ig G production. Double vision improved after corticosteroid mega-doses. CONCLUSIONS: An acute onset of diplopia due to divergence insufficiency in a young adult may be associated with a demyelinating disorder.- - - - - - - - - - ranking = 0.14285714285714keywords = horizontal (Clic here for more details about this article) |
10/73. spasm of the near reflex associated with head injury.spasm of the near reflex is characterized by intermittent miosis, convergence spasm and pseudomyopia with blurred vision at distance. Usually, it is a functional disorder in young patients with underlying emotional problems. Only rarely is it caused by organic disorder. We report a patient who developed convergent spasm associated with miosis after head trauma at the age of 84 years.- - - - - - - - - - ranking = 2.8725171548381keywords = convergence (Clic here for more details about this article) |
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