Cases reported "Strabismus"

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1/16. The role of restricted motility in determining outcomes for vertical strabismus surgery in Graves' ophthalmology.

    OBJECTIVE: To identify factors predictive of operative success or failure for vertical muscle surgery performed in patients with Graves' ophthalmopathy. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Thirty-one consecutive patients with Graves' ophthalmopathy who demonstrated vertical ocular motor imbalance, with or without simultaneous horizontal muscle imbalance. INTERVENTION: Vertical extraocular muscle surgery performed either in isolation or in association with horizontal muscle surgery. MAIN OUTCOME MEASUREMENTS: Vertical limitations of extraocular muscles were correlated with preoperative hypertropia. Stepwise linear regression was used to determine the significant predictors of postoperative hypertropia in primary gaze. Logistic analysis was used to estimate the probability of surgical failure (>5 diopters) on the basis of preoperative parameters. RESULTS: The amount of preoperative hypertropia was negatively correlated with total restriction of vertical ductions (r = -0.52, P < 0.01). Preoperative hypertropia was positively correlated with asymmetry in muscle restriction between the two eyes (r = 0.67, P < 0.0001). The best predictor of preoperative hypertropia was the difference between restriction of the contralateral opposing recti, namely the right superior rectus, and the left inferior rectus, as well as the right inferior rectus and the left superior rectus (r = 0.74, P < 0.0001). Restriction of the contralateral opposing recti was also the most significant predictor of surgical success (postoperative hypertropia < 5 prism diopters). CONCLUSIONS: Surgery tailored to address restriction of ductions, specifically the difference between contralateral opposing recti, is likely to improve the success of initial surgery beyond that based primarily on the magnitude of the vertical deviation.
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keywords = ophthalmopathy
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2/16. Anterior segment ischemia and retinal detachment after vertical rectus muscle surgery.

    PURPOSE: The authors describe the clinical course of a woman who developed two complications following vertical strabismus repair: anterior segment ischemia (ASI) and retinal detachment. methods: A 62 year-old woman is described. She presented with new onset proptosis and left hypertropia with significant diplopia in all fields of gaze. This presentation, her 15 year history of thyroid disease, and preoperative computed tomography (CT) of the orbits were consistent with Graves' ophthalmopathy. Vertical strabismus repair was carried out by recessing the left superior rectus muscle and resecting the left inferior rectus muscle. RESULTS: The diplopia was eliminated. The patient developed significant postoperative ASI and iatrogenic rhegmatogenous retinal detachment in the left eye due to unsuspected globe perforation. She was treated with systemic corticosteroids and radial scleral buckling. CONCLUSIONS: Severe ASI following strabismus surgery is a well recognized complication, with age, thyroid ophthalmopathy, and manipulation of the vertical rectus muscles as risk factors. The retinal detachment soon after strabismus surgery was difficult to detect, possibly due to diminished visualization of the posterior segment as a result of ASI.
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keywords = ophthalmopathy
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3/16. Late recurrence of unilateral graves orbitopathy on the contralateral side.

    PURPOSE: To report a case of late recurrence of unilateral Graves orbitopathy on the contralateral side after 7 years. DESIGN: Interventional case report. methods: A 44-year-old woman with left unilateral Graves orbitopathy underwent two-wall orbital decompression on the left side. After strabismus surgery and left upper eyelid surgery, she was discharged. RESULTS: Seven years after discharge, the patient developed Graves orbitopathy on the right side, and she underwent two-wall orbital decompression on the right side. CONCLUSION: At least in patients with unilateral Graves orbitopathy, late recurrence of the disease in the contralateral orbit may occur.
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keywords = grave
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4/16. High myopia as an unusual cause of restrictive motility disturbance.

    Endocrine ophthalmopathy is a common cause of restrictive ocular motility disorder associated with abnormal forced duction testing. We report ultrasonographic and computed tomographic findings in a highly myopic patient without thyroid abnormality in whom the restrictive findings of endocrine ophthalmopathy were simulated by contact between elongated globes and the bones of the orbital apices.
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keywords = ophthalmopathy
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5/16. Necrotizing scleritis following strabismus surgery for thyroid ophthalmopathy.

    Necrotizing scleritis with inflammation of the right eye developed after bilateral eye muscle surgery for thyroid ophthalmopathy. Debilitating pain, delay in onset, and involvement of the sclera distinguish this condition from anterior segment ischemia. The surgery may have acted as a nonspecific trigger in an eye at risk for scleritis. Necrotizing scleritis has occurred infrequently after other types of eye surgery but, to our knowledge, has not been previously reported as a complication of eye muscle surgery.
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keywords = ophthalmopathy
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6/16. Fadenoperation for the management of complicated incomitant vertical strabismus.

    We reviewed retrospectively the records of 17 patients with incomitant vertical diplopia secondary to an underacting inferior rectus muscle who had been treated by surgically weakening the contralateral inferior rectus muscle with a posterior fixation suture (fadenoperation). This was the sole procedure in four patients with blowout fractures and in two patients with restriction secondary to scleral buckling procedures. It was combined with horizontal or vertical muscle surgery in 11 patients. The procedure was particularly useful in preventing diplopia on downgaze after excessive weakening of a tight inferior rectus muscle in seven patients with thyroid ophthalmopathy. In three patients it was used in anticipation of an iatrogenic incomitancy in downgaze secondary to a large recession of a tight inferior rectus muscle. All patients were markedly improved after surgery and no complications were encountered.
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keywords = ophthalmopathy
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7/16. Anterior segment ischemia treated with hyperbaric oxygen.

    Anterior segment ischemia developed in a 62-year-old dysthyroid patient after two-muscle adjustable suture repair of vertical strabismus. Because of a quiescent pulmonary tuberculous focus he was not treated with systemic steroid therapy but rather with hyperbaric oxygen in the controlled environment of our hospital hyperbaric chamber. He tolerated this treatment well, and his acute symptoms almost completely resolved in 3 days. We believe this to be the first reported case of the use of hyperbaric oxygen in the management of anterior segment ischemia. We also believe it is the first reported case of anterior segment ischemia following surgery to two opposing, not contiguous, rectus muscles in dysthyroid ophthalmopathy.
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keywords = ophthalmopathy
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8/16. Use of computerized axial tomography (CAT scan) in evaluating therapy of orbital pseudotumor.

    Two patients with orbital pseudotumor, demonstrated by computerized axial tomography (CAT scan), are presented. This radiological technique was further used to demonstrate the complete resolution (Case 1) and marked regression (Case 2) of the orbital masses after steroid therapy. CAT scan characteristics of orbital pseudotumor were discussed and contrasted with the findings in thyroid ophthalmopathy. It is our recommendation that patients with CAT scan and clinical characteristics of orbital pseudotumor should be treated with systemic steroids and resolution of the inflammatory lesion should be corroborated by a repeat scan in atypical cases. Orbital surgery and other invasive studies should be used in those patients in whom there is no objective improvement in the disease process.
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ranking = 0.5
keywords = ophthalmopathy
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9/16. Managing strabismus in endocrine eye disease.

    In Graves' ophthalmopathy, now considered a separate autoimmune disorder, 15% of patients have a motility disorder. This is usually a restrictive strabismus, most often involving the inferior rectus muscle, and is diagnosed with the aid of forced duction testing, saccadic velocity measurement, binocular visual field testing and prism cover testing. Adjustable sutures may be used, depending on the intraoperative findings. The case presentations in this paper demonstrate the principles of diagnosis and treatment.
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ranking = 0.5
keywords = ophthalmopathy
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10/16. Anterior segment ischemia following strabismus surgery.

    Anterior segment ischemia (ASI) is a potentially blinding complication of extensive eye muscle surgery. Eyes have been described with this complication following surgery on as few as two rectus muscles, especially in patients with thyroid dysfunction or other medical illnesses. In an attempt to assess the risk of ASI, we have reviewed the records of 34 eyes in 26 patients who underwent surgery on three or four rectus muscles. Seven eyes of six patients with thyroid ophthalmopathy which underwent two-or three-muscle surgery were also studied. Evidence of clinically significant ASI was apparent in only one patient during a follow-up period of seven months to eleven years. This case was mild and no visual loss resulted. Our findings suggest that surgery on three or four rectus muscles in healthy patients is probably safe when performed in a staged fashion.
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keywords = ophthalmopathy
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