Change of eye position in patients with orthophoria and horizontal strabismus under general anesthesia

We studied the relationship between eye position in the awakened state and in the surgical plane of anesthesia in orthophoric and horizontal strabismus patients. We classified 105 orthophoric and horizontal strabismus patients into 5 groups, measured the eye position at the primary position by photographic measurement of the corneal reflex positions and undertook a quantitative study of eye position. Under general anesthesia, the mean divergence was 39.7+/-8 PD for the esotropia group, 36.6+/-11.7 PD for exophoria, 27.4+/-8.1 PD for orthophoria, and 11.1+/-10.2 PD for exotropia I (< or =30 PD). Therefore, the esotropia group had the largest amount of divergence among the groups, but the eye position of the exotropia II (>30 PD) group was rather convergent at 11.0+/-6.5 PD. According to the eye position of the fixating and nonfixating eyes in the esotropia group, both eyes converged with an angle deviation of 14.4+/-4.8 PD divergent and 14.1+/-4.8 PD divergent, respectively (P=.71). In the exotropia groups (I, II), the fixating eye diverged but the nonfixating eye rather converged. Therefore, the angle deviation was 19.0+/-2.1 PD divergent for the fixating eye and 18.2+/-6.4 PD divergent for the nonfixating eye (P=.68). In conclusion, under general anesthesia, eye positions in the awakened state and in the surgical plane of anesthesia were convergent or divergent, and showed a tendency to converge into the position of 25-35 PD divergent. Therefore, we could not distinguish fixating eye from nonfixating eye under general anesthesia.     

Astigmatism in children with epiblepharon

PURPOSE: To study the relationship between astigmatism and epiblepharon in Taiwanese children that need surgical correction. METHODS: In a retrospective case-control study, a total of 254 eyes in 134 children surgically treated for lower-lid epiblepharon were studied. A further 205 eyes in 104 children 4-7 years of age were included as controls. Data on age, sex, severity of preoperative corneal erosion, best-corrected visual acuity, and preoperative and postoperative refractive errors were recorded. The data of astigmatism were decomposed into P90 (at 90 degrees) and its oblique meridian Pobl. Nonparametric tests were used to compare the severity of astigmatism. RESULTS: No significant difference between age group (<4, 4-7, >7 years) in P90 was shown in children with epiblepharon. Pobl was trivial in each group of epiblepharon. Children with epiblepharon 4-7 years of age had significantly (P < 0.001) greater P90 than controls (1.12 vs. 0.47 D). P90 and Pobl were not significantly changed postoperatively. In the same individual, the eye with the more severely affected cornea had greater astigmatism (P = 0.002), even after the corneal erosion healed. CONCLUSIONS: Children with epiblepharon who needed surgery had greater with-the-rule astigmatism than controls. More severe corneal erosion was associated with higher astigmatism. Surgical correction of skinfold and promotion of reepithelialization did not attenuate astigmatism significantly.     

Conjunctival epithelial changes induced by cilia in patients with epiblepharon or entropion

PURPOSE: To evaluate the effect of mechanical trauma induced by cilia on the conjunctival epithelium in patients with epiblepharon or entropion and to evaluate changes in epithelium after surgical correction in patients with entropion. DESIGN: Case-control study. METHODS: One hundred and seven eyes of 61 patients were enrolled in this study and were divided into three groups: the epiblepharon group (n = 59), the entropion group (n = 17), and the age-matched control group for the epiblepharon group (n = 31). Impression cytologic specimens were obtained from nasal and temporal bulbar conjunctiva of the epiblepharon and control groups immediately after the induction of general anesthesia. In the entropion group, these were obtained before and one month after surgical correction. Conjunctival changes were graded using the Tseng method and goblet cell densities were compared. RESULTS: Cytologic scores were significantly higher in the epiblepharon group than in the control group (P < .001), and goblet cell densities of nasal and temporal conjunctiva were significantly lower in the epiblepharon group than in the control group (P = .044 and P = .018, respectively). In the entropion group, postoperative scores were significantly lower than preoperative scores in both conjunctival areas (P = .033 and P = .003, respectively). No statistically significant difference was found between nasal and temporal conjunctiva in the three groups. CONCLUSIONS: The persistent mechanical trauma by cilia in patients with epiblepharon or entropion can induce squamous metaplasia of the conjunctival epithelium. However, these conjunctival changes can be reversed by surgical correction.     

Connective tissue changes associated with inferior epiblepharon, epicanthus, and keratoconus

A 34-year-old woman with bilateral inferior epiblepharon, epicanthus, and keratoconus is presented. Biopsies of right upper arm skin, left lower eyelid, and left cornea were sectioned and examined by electron and indirect immunofluorescent microscopy. Pathologic changes in both the skin and cornea were observed. Indirect immunofluorescent techniques showed an increase in fibronectin and procollagen type I in the subcutaneous tissue of the skin and an increase of procollagen type I in the deep dermis of the right upper arm skin and left lower eyelid. Increased amounts of laminin in the basal epithelium of the cornea and of collagen type III in the stroma and subepithelial components of the stroma were observed. Electron microscopy disclosed disordered arrays of collagen fibers in the right upper arm skin and left lower eyelid, and typical changes of keratoconus, with scars in the cornea. Both the cornea and skin had thin fibrillar extensions between collagen fibers.     

儿童睑赘皮的屈光状态分析

目的了解我国儿童睑赘皮的屈光状态并进一步探讨儿童睑赘皮的治疗时机。方法对101例(202只眼)住院手术治疗的睑赘皮儿童的屈光状态进行回顾性分析。结果睑赘皮儿童散光(≥0.75D)的患病率73.76%,高于普通儿童(P<0.001);近视(≤-0.50D)和远视(≥+2.0D)的患病率分别为40.10%和6.43%,与普通儿童相比无明显差异(P>0.05)。散光的轴向分布为顺规散光82.55%,逆规散光8.05%,斜轴散光9.40%,以顺规散光为主(P<0.001),斜轴散光的比例较普通儿童减少(P=0.0289)。结论睑赘皮儿童伴有较高的散光患病率以及较高的散光度,对于伴有明显屈光异常的睑赘皮患儿,应及时干预以消除屈光异常对视觉发育的影响。     

Nd:YAG laser capsulotomy in the prone position under general anesthesia.

Neodymium:YAG (Nd:YAG) capsulotomy is the most common treatment for posterior capsule thickening. Occasionally, patients are unsuitable for receiving this treatment by slit lamp and require alternative surgical options. A technique enabling patients to undergo Nd: YAG laser capsulotomies while under general anesthesia is described. After induction of anesthesia in the supine position, the patient is transferred into the prone position and his or her neck is extended with the chin supported onto the Nd:YAG laser delivery slit lamp before the administration of the laser treatment. The procedure was performed in three individuals, who experienced good outcomes.     

Eye position and electromyographic observation of squint eyes under general anesthesia.

The position of eyes under general anesthesia was measured in different groups of nonparalytic strabismus. Almost all patients with esotropia or hyperactive inferior oblique muscle showed divergent eye positions while patients with exotropia showed no consistent trend. The eye position of patients with lid ptosis without squint, which served as a control group, were divergent in all cases. Electromyographic observation of the medial rectus muscle under the same condition of anesthesia revealed that muscle discharge disappeared almost completely at the stage at which the eyes were in a well-stabilized position.     

麻醉诱导期Slipa喉罩和气管导管对眼的影响

目的比较麻醉诱导期Slipa喉罩和气管导管对患者眼的影响。方法乳腺良性病变切除术50例,年龄20～50岁,体质量45—70kg,眼压（IOP）12～18mmHg（1mmHg=0．133kPa）,按照随机数字表法平均分为两组：Slipa喉罩组（s组）和气管导管组（c组）。两组均静脉注射丙泊酚、瑞芬太尼、顺苯磺阿曲库铵行麻醉诱导,待下颌松弛后s组置入Slipa喉罩,C组插入气管插管后行机械通气。于诱导前（基础值11D）、插管或置喉罩前（T1）、插管或置喉罩后即刻（T2）、插管或置喉罩后1min（T3）、2min（T4）、5min（T5）测定IOP、平均动脉压（MAP）和心率（nR）。结果与rm比较,两组在T1时点IOP、MAP及HR明显降低;与T1比较,S组存T2-T5各时点IOP、MAP及HR均趋于平稳,差异无统计意义,C组1、2、13、T4各时点IOP、MAP及HR明显升高,T5时点IOP、MAP及HR均下降;与s组比较,C组T2、T3、T4各时点IOP、MAP及HR升高,T1和T5两时点组间比较,差异无统计学意义;S组和C组MAP与IOP呈正相关（r=0．832,0．829,P〈0．05）。结论与气管插管相比,Slipa喉罩在麻醉诱导中的应用可有效预防IOP的升高,且麻醉诱导过程血流动力学趋于稳定。     

Lid margin split in the surgical correction of epiblepharon

Purpose: To describe the technique of splitting the lid margin combined with the excision of redundant skin and muscle during the surgical correction of epiblepharon and to report its clinical outcome. Methods: A combined procedure that included splitting the lid margin to repair lower eyelid epiblepharon was performed on 31 eyes of 19 consecutive patients. Lid margin splitting was performed along the grey line on the medial third or half of the lower eyelid by making a 1 mm‐deep incision. Having made a transverse subciliary skin incision and a dissection between the tarsus and the orbicularis oculi muscle, the subcutaneous tissue of the superior edge of the incision was secured to the tarsus with interrupted sutures to evert the cilia. An excision of the redundant skin and orbicularis tissue was made and the skin was closed. The patients were followed for direct inspection of the wound, the split lid margin, the direction of the lashes and the status of the cornea. Results: The mean postoperative follow‐up period was 29.4 weeks. Symptoms disappeared in all patients. In 30 eyelids of 19 patients the cilia did not touch the cornea, even in the down‐gaze. In one eyelid the cilium touched the medial conjunctiva, but not the cornea. The cosmetic outcome of the lower lid was satisfactory in all cases and the wounds of the split lid margin healed without scarring. To date, there have been no complications such as wound dehiscence, ectropion or eyelid retraction. Conclusions: The lamellar splitting of the lid margin is a beneficial addition to the repair of prominent lower lid epiblepharon, especially on the medial aspect of the eyelid. This simple technique ensures easier eversion of the cilia in epiblepharon repair, without disturbing the posterior lamella or causing unfavourable results.