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1/78. Anterior segment ischemia and sector iris atrophy: after strabismus surgery in a patient with chronic lymphocytic leukemia.

    A 69-year-old woman with chronic lymphocytic leukemia developed segmental iris atrophy and iridocyclitis after routine surgery for exotropia. Both the clinical picture and fluorescein angiogram indicated anterior segment ischemia. It is postulated that this was related to hyperviscosity of the blood caused by a high white blood cell count (114,000/cu mm). The possibility of anterior segment ischemia should be kept in mind when contemplating strabismus or retinal detachment surgery in the presence of hematologic disorders likely to increase blood viscosity. In these cases a minimal amount of surgery should be done with proper supportive therapy. strabismus surgery should be done in stages allowing for hemodynamic compensation between procedures.
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ranking = 1
keywords = strabismus, exotropia
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2/78. Neuromyotonia of the abducens nerve after hypophysectomy and radiation.

    The clinical signs of the rarely encountered ocular neuromyotonia consist of transient involuntary tonic contraction and delayed relaxation of single or multiple extraocular muscles, resulting in episodic diplopia. With a mean time delay of 3.5 years, this motility disorder frequently follows tumor excision or adjuvant radiation near the skull base. Ocular neuromyotonia may reflect inappropriate discharge from oculomotor neurons with unstable cell membranes because of segmental demyelinization by tumor compression and radiation-induced microangiopathy. In the present paper, the authors present the case of a 53-year-old patient with a history of transsphenoidal hypophysectomy and adjuvant radiotherapy, who underwent strabismus surgery for abducens palsy.
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ranking = 0.16917021747015
keywords = strabismus
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3/78. Transient exotropia after posterior spinal fusion in a child: a new case.

    Ocular complications after spinal surgery are rare, although ischemic optic neuropathy, occipital lobe infarcts, and central retinal vein thrombosis have been reported. Our purpose is to report a case of an acute, comitant, postoperative exotropia that rapidly and spontaneously resolved. This case is particularly interesting in that it may indirectly shed some light on mechanisms of vergence control.
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ranking = 0.77074456324628
keywords = exotropia
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4/78. Primary localized conjunctival amyloidosis following strabismus surgery.

    A 13-year-old white boy developed bilateral polypoid conjunctival masses overlying the lateral rectus muscles six months after surgery for divergent strabismus. Histologic examination confirmed the presence of amyloid in these lesions.
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ranking = 0.84585108735074
keywords = strabismus
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5/78. endophthalmitis after pediatric strabismus surgery.

    OBJECTIVE: To report 6 cases of endophthalmitis after pediatric strabismus surgery. methods: Retrospective review of initial signs, clinical findings, treatment, culture results, and visual and anatomical outcomes in 6 eyes of 6 children treated at 2 tertiary care institutions between 1983 and 1998. RESULTS: Four boys and 2 girls aged 8 months to 6 years (median age, 2 years) developed lethargy and asymmetric eye redness, with or without eyelid swelling or fever, within 4 days of surgery. At diagnosis (median, postoperative day 6) clinical findings included periorbital swelling, redness and leukocoria due to vitritis, and, in some cases, hypopyon. Treatment included pars plana vitrectomy and intravitreal and systemic antibiotics in all cases. Vitreous cultures grew streptococcus pneumoniae, haemophilus influenzae, and staphylococcus aureus. Within 6 months of strabismus surgery, visual acuity was no light perception in all eyes and 3 eyes had been enucleated. The 3 remaining eyes were prephthisical. CONCLUSIONS: endophthalmitis after pediatric strabismus surgery is rare. Children may not recognize or verbalize symptoms. Causative organisms are virulent. Visual and anatomical outcomes are poor. lethargy, asymmetric eye redness, eyelid swelling, or fever in the postoperative period, even if initial postoperative examination results are normal, should prompt urgent ocular examination. The diagnosis of endophthalmitis may be made when biomicroscopic or indirect ophthalmoscopic examination confirms the presence of vitreous opacification with or without hypopyon. Arch Ophthalmol. 2000;118:939-944
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ranking = 1.184191522291
keywords = strabismus
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6/78. Thermal cautery as a treatment for conjunctival inclusion cyst after strabismus surgery.

    Conjunctival cysts may be congenital or acquired. A common cause of acquired conjunctival inclusion cysts is the implantation of conjunctival epithelium after surgery or trauma. These cysts often form at the site of muscle reattachment after strabismus surgery. They may disappear spontaneously, but persistent cases often require surgical excision. We report a new technique using cauterization under slit-lamp visualization to treat conjunctival inclusion cysts that can form after strabismus surgery. This procedure is fast, effective, and well tolerated by patients.
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ranking = 1.0150213048209
keywords = strabismus
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7/78. Delayed orbital hemorrhage after routine strabismus surgery.

    PURPOSE: To report a case of delayed rectus muscle hemorrhage after strabismus surgery. methods: Case report. RESULTS: Rectus muscle hemorrhage occurred 36 hours after strabismus surgery in a 26-year-old man, causing temporary loss of vision and reduced ocular motility. Urgent lateral cantholysis and orbital exploration to restore hemostasis were undertaken. Full recovery of vision occurred and a small residual motility disturbance was present 3 months postoperatively. CONCLUSION: Delayed rectus muscle hemorrhage poststrabismus surgery is rare but can have sight-threatening effects. When vision is threatened because of optic nerve compromise, urgent orbital exploration may allow full recovery of function.
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ranking = 1.184191522291
keywords = strabismus
(Clic here for more details about this article)

8/78. 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.
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ranking = 0.3383404349403
keywords = strabismus
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9/78. A case of paradoxical diplopia in large-angle consecutive exotropia.

    PURPOSE: To describe the investigation and subsequent management of paradoxical diplopia in unsightly exotropia. A 32-year-old lady requested surgical correction of a large manifest consecutive exotropia which, on initial correction with any base-in prism, was accompanied by paradoxical diplopia. methods: Botulinum toxin to the right lateral rectus reduced the deviation to 30 delta over a one-week period. The residual deviation was corrected with base-in Fresnel prisms which the patient wore constantly for another two weeks. Although there was demonstrable diplopia initially, it disappeared after 3-4 days of prism wear. Surgery was carried out comprising right lateral rectus recession (6 mm) and right medial rectus advancement from 12 mm to 6 mm posterior to the limbus. RESULTS: There was no diplopia following the surgery and the residual exodeviation measured 6 delta for near and 16 delta for distance (fixing OD). The patient remains symptom-free and cosmetically excellent. CONCLUSION: A gradual progressive reduction in the deviation using a combination of Botulinum toxin and prisms allowed a more informative conclusion to be made regarding the potential post-operative sensory status in this patient, by allowing her to slowly adjust to an altered ocular alignment. In patients with non-functional strabismus who may be at risk from post-operative diplopia, a trial with prisms over a few weeks with or without the addition of Botulinum toxin is advocated.
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ranking = 1.0940636933657
keywords = strabismus, exotropia
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10/78. Late-onset progressive strabismus associated with a hydrogel scleral buckle.

    A hydrophilic implant for scleral buckling was developed in 1980. Advantages include softness and elasticity, no dead spaces, ability to gradually absorb and release antibiotics, and stimulating production of a fibrous capsule around the implant. Short-term fellow studies in rabbits showed no clinical or histologic complications. Long-term complications of the hydrogel scleral buckle have emerged in the las 10 years. These included fragmentation, subconjunctival bulging, intraocular erosion, migration, and restriction of extraocular movement. We recently encountered a patient with progressive restrictive strabismus beginning 8 years after retinal detachment repair with a MIRAgel (hydrogel; MIRA, Uxbridge, MA) scleral buckle. Worsening complaints of diplopia and discomfort led to strabismus surgery. Untreatable retinal detachment resulted in enucleation.
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ranking = 1.0150213048209
keywords = strabismus
(Clic here for more details about this article)
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