Combined superior oblique muscle recession and inferior oblique muscle advancement and transposition for cyclotorsion associated with macular translocation surgery.

PURPOSE: The purpose of this study was to evaluate the effects of oblique muscle surgery on the large-angle incyclotorsion resulting from macular translocation surgery for severe age-related macular degeneration. METHODS: Patients undergoing macular translocation (superiorly) at our institution from May 1996 until November 1998 were included. In the Staged Group, strabismus surgery for symptomatic incyclotorsion was performed after the macular translocation, and in the Combined Group, it was performed simultaneous with the macular translocation. Cyclotorsion was quantified using Maddox rod testing. Surgery for incyclotorsion included superior oblique muscle recession combined with inferior oblique muscle advancement and transposition in the affected eyes. The minimum follow-up time was 6 weeks. RESULTS: Fifteen patients (15 eyes) were included (ages 66-89 years). Nine eyes (Baseline Group) had macular translocation surgery before any strabismus surgery; the mean postoperative incylotorsional angle was 33.4 +/- 18.3 degrees (range, 20-80 degrees) after a mean follow-up of 6.6 months. Four of these eyes (Staged Group) underwent oblique muscle surgery for symptomatic incyclotorsion, which reduced the mean incyclotorsion from 26.9 +/- 6.9 degrees (range, 20-35 degrees) to 9. 9 +/- 7.9 degrees (range, 2.5-20 degrees)-a mean reduction of 16.9 +/- 1.3 degrees (P =.00012), after a mean follow-up of 4.6 months. Six additional eyes (Combined Group) had simultaneous macular translocation and oblique muscle surgery, with a mean postoperative cyclotorsional angle of 14.0 +/- 6.7 degrees (range, 4-22.5 degrees), after a mean follow-up of 3.75 months. CONCLUSION: Oblique muscle surgery is effective at reducing the large degree of incyclotorsion resulting from macular translocation surgery and may be used either following or simultaneous with retinal surgery.     

Strabological findings after macular translocation surgery with 360 degrees retinotomy

PURPOSE: To examine the strabological findings after macular translocation surgery with a 360 degrees retinotomy. METHODS: Thirty-two patients who underwent macular translocation surgery were divided into three groups based on their responses to the Bagolini striated lenses test: fusion, ignoring the image, and diplopia. The relevant factors affecting binocularity were compared among the three groups. RESULTS: Five patients had peripheral fusion and three of these had gross stereopsis. Fifteen patients ignored the second image, and 12 patients had diplopia. The objective angle of macular rotation was smaller in the patients with peripheral fusion (15.0 +/- 6.1 degrees) than in those with diplopia (32.7 +/- 11.7 degrees). The subjective angle of cyclotorsion in those with peripheral fusion (6.0 +/- 4.2 degrees) was smaller than in those who ignored the image ("ignoring" group; 20.5 +/- 9.19 degrees) and the diplopia group (30.7 +/- 12.8 degrees). The amount of torsional sensory compensation in patients with diplopia (2.08 +/- 3.83 degrees) was significantly smaller than in those with peripheral fusion (9.00 +/- 7.42 degrees) and in the ignoring group (6.73 +/- 3.86 degrees). Patients with peripheral fusion were significantly younger (54.2 +/- 14.3 years) than those in the ignoring group (67.7 +/- 10.0 years) and those with diplopia (68.0 +/- 5.4 years). CONCLUSIONS: Adaptive mechanisms are activated to reduce the surgically induced objective angle of cyclotorsion, and a cyclodeviation of 15 degrees was the critical angle separating those who had peripheral fusion from those who did not. This value corresponds to the cyclofusional amplitude in normal adults.     

Diplopia after limited macular translocation surgery

PURPOSE: Full macular translocation surgery relocates the fovea away from choroidal neovascularization, inducing significant postoperative torsional diplopia. In "limited macular translocation," a saline-induced retinal detachment is followed by scleral imbrication with mattress sutures and spontaneous retinal reattachment. In this study, diplopia was characterized in patients treated with limited macular translocation. METHODS: Two surgeons performed retinal translocation surgery on 250 patients over an 18-month time span. The extent and direction of the retinal translocation, and the amount and location of scleral imbrication, were recorded. All patients complaining of diplopia were referred for ocular motility evaluation and treatment. RESULTS: Thirteen (5.2%) patients complained of occasional or constant diplopia. Imbricating sutures were placed supero-temporally in all cases. Inferior foveal translocation ranged from 200 to 2115 microm (median, 1750 microm). Visual acuity ranged from 20/40 to 20/400 in the operated eye. Prism-and-cover testing underestimated the strabismus when compared with subjective testing. In 3 patients, there was no shift on alternate-cover testing despite binocular diplopia. Excyclotorsion ranged from 0 degrees to 16 degrees. Diplopia resolved in 10 cases with prism; 3 required an occlusive filter for distortion or aniseikonia. One patient underwent successful strabismus surgery to eliminate dependence on prism glasses. CONCLUSIONS: Limited macular translocation only rarely produces symptomatic diplopia. Suprisingly, traditional prism-and-cover testing does not reliably quantify the misalignment. This may result from the combination of a persistent macular scotoma and a repositioned fovea relative to the peripheral retina. Prism therapy is generally satisfactory in the absence of retinal distortion or aniseikonia.     

360度视网膜切开致黄斑转位性斜视的临床分析

目的 :针对应用 36 0°视网膜切开术治疗复杂性视网膜脱离出现黄斑转位的患者 ,分析发生视网膜旋转、黄斑转位的原因 ,并探讨旋转性斜视和复视的诊断及治疗。方法 :2例因视网膜脱离合并严重前增殖性玻璃体视网膜病变患眼 ,行松弛性 36 0°视网膜切开术后视网膜复位 ,但发生黄斑转位。观察患者手术前后的视力、双眼视功能、主客观偏斜和眼位情况、视网膜旋转度数及黄斑移位程度。结果 :病例 1随诊 2 1个月 ,术后 15个月取出硅油 ,视力从眼前光感提高到 0 0 1;病例 2随诊 3个月 ,硅油存留 ,视力从眼前光感提高到 0 0 3。 2例患者均有垂直和水平斜视 ,黄斑旋转 4 0°～ 5 0° ,黄斑移位约 1 5DD(discdi ameter,视盘直径 ) ,均有主观视物偏斜症状。结论 :36 0°视网膜切开术可能造成视网膜旋转、黄斑转位 ,出现旋转性斜视和复视。     

Visual function after foveal translocation with 360-degree retinotomy and simultaneous torsional muscle surgery in patients with myopic neovascular maculopathy

PURPOSE: To assess functional and anatomical outcomes after foveal translocation with 360-degree retinotomy and simultaneous torsional muscle surgery in patients with myopic neovascular maculopathy. METHODS: Foveal translocation with 360-degree retinotomy was performed in 11 eyes of 11 patients with myopic neovascular maculopathy. Ten eyes had simultaneous torsional muscle surgery with recession of the superior oblique muscle and tucking of the inferior oblique muscle. Silicone oil removal with or without intraocular lens implantation was performed 2 to 8 weeks after the primary procedure. Visual acuity, binocular function, and degree of cyclotorsion were assessed preoperatively and postoperatively. Angles of retinal and globe rotation, distance of foveal shift, and surgical complications were also investigated. RESULTS: With a mean postoperative follow-up of 6.2 months (range, 3 to 13 months), vision improved (greater than 0.2 logarithm of minimal angle of resolution [logMAR] units) in eight eyes, was unchanged in two eyes, and worsened (greater than 0.2 logMAR units) in 1 eye. Seven of 11 eyes (64%) had a final visual acuity of 20/50 or better. Five patients developed or maintained binocular fusion, four patients continued to have suppression, and two patients developed diplopia that was managed by spectacles with Fresnel prisms. Subjective cyclotorsion was less than 8 degrees in 10 eyes. Mean retinal and globe rotations were 23.4 degrees and 19.8 degrees, respectively. Average size of the choroidal neovascular membrane was 0.8 disk diameter, whereas the average distance of foveal shift was 1.5 disk diameter. After the primary procedure, three eyes developed retinal detachment, one eye macular hole, and one eye proliferative vitreoretinopathy. These complications were successfully managed by additional surgery. CONCLUSION: Foveal translocation with 360-degree retinotomy is effective in restoring vision in some patients with myopic neovascular maculopathy. Although the development of torsional diplopia is generally obviated by simultaneous extraocular muscle surgery, a relatively high incidence of surgical complications should be taken into account with this procedure.     

Effect of simultaneous oblique muscle surgery in foveal translocation by 360° retinotomy

PURPOSE: To assess the effect of simultaneous oblique muscle surgery during foveal translocation surgery with 360 degrees retinotomy in patients with neovascular maculopathy. METHODS: Foveal translocation with 360 degrees retinotomy was performed on 31 eyes of 31 patients with neovascular maculopathy (21 with age-related macular degeneration 9 with myopic neovascular maculopathy, and 1 with idiopathic neovascular maculopathy). All eyes had simultaneous torsional muscle surgery with recession of the superior oblique muscle and tucking of the inferior oblique muscle. Visual acuity, binocular vision, and degree of cyclotorsion were assessed pre- and postoperatively. The angles of retinal and global rotation, distance of foveal shift, and surgical complications were also investigated. RESULTS: With a mean postoperative follow-up of 10.0 months, vision improved (>0.2 log MAR units) in 13 eyes, was unchanged in 9 eyes, and worsened (>0.2 log MAR units) in 9 eyes. Ten of 31 eyes (32%) had a final visual acuity of 20/50 or better. Eleven patients had binocular fusion, 13 patients showed suppression, and 7 patients developed diplopia that was managed by spectacles with prisms or by secondary muscle surgery. The mean retinal and global rotations were 30.3 degrees and 23.7 degrees, respectively. The average size of the choroidal neovascular membrane was 1.3 disc diameters (DD), while the average shift of the fovea was 1.5 DD. After the primary surgery, six eyes developed retinal detachment, two eyes macular hole, and three eyes proliferative vitreoretinopathy. These complications were successfully managed by additional surgery. CONCLUSION: Foveal translocation with 360 degrees retinotomy is effective in restoring vision in 40% of patients with neovascular maculopathy. Simultaneous oblique muscle surgery was effective in rotating the globe by about 20 degrees, corresponding to to a foveal shift of 1.5 DD. While the development of torsional diplopia is generally prevented by simultaneous oblique muscle surgery, the relatively high incidence of surgical complications with this procedure should be taken into account.     

Surgery for strabismus secondary to ethmoid sinus surgery

PURPOSE: To review the outcome of surgery for strabismus due to ethmoid sinus surgery. CASES AND METHODS: The series comprised 13 cases, 1 of inferior rectus paresis, 1 of superior oblique paresis, 6 of medial rectus paresis, and 5 of medial rectus muscle palsy due to third nerve palsy. In the cases of paresis of the rectus muscle, resection of the rectus muscles was mainly performed. In the cases of palsy of the rectus muscle, transposition of the extraocular muscle with simultaneous recession of the lateral rectus muscle was performed. The major aim of surgery was to bring both eyes into alignment and to eliminate diplopia in the primary position. RESULTS: The mean preoperative horizontal deviation of 18.1 degrees of exotropia in the paresis cases was reduced to 1.4 degrees of exotropia after surgery. The mean preoperative vertical deviation of 3.8 degrees of hypertropia was reduced to 1.4 degrees of hypertropia postoperatively. The mean preoperative horizontal deviation of 35.6 degrees of exotropia in the palsy cases was reduced to 9.4 degrees of exotropia after surgery. The mean preoperative vertical deviation of 2.0 degrees of hypertropia was increased to 2.6 degrees of hypertropia postoperatively. Postoperatively, diplopia was absent in 11 cases with a slightly compensatory head posture. CONCLUSION: Surgery for strabismus due to sinus surgery induces improvements in eye position and diplopia.     

Masked bilateral superior oblique palsy

BACKGROUND: A diagnosis of masked bilateral superior oblique palsy (MBSOP) is established when signs of SOP appear in the normal eye of a patient after strabismus surgery for SOP in the contralateral eye. Despite the absence of signs of bilaterality before surgery, a palsy will develop in the previously unaffected eye in 10% or more of the patients undergoing surgery. This paper examines the clinical profiles and results of surgical management of 14 patients with MBSOP. METHODS: We retrospectively analysed the records of all 14 patients with the clinical criteria for MBSOP in the clinical strabismus database of patients treated by the second author between 1979 and 2001. We extracted the history and data from the pre- and postoperative ophthalmic and orthoptic examinations, recorded the surgical procedures and tabulated the postoperative results. The surgical outcome was considered successful if normal head posture was restored, diplopia was eliminated in functional positions of gaze, and ocular alignment was improved to within 5 prism dioptres (PD) of orthotropia. RESULTS: All 14 patients had presented with seemingly unilateral SOP. The average primary-position hypertropia preoperatively was 17 (range 4-30) PD. The mean excyclotorsion was 5 degrees (n = 12). Most patients (93%) had a head tilt, mild V pattern, moderate inferior oblique overaction and mild superior oblique underaction. Initial surgery consisted of ipsilateral inferior oblique weakening with or without contralateral inferior rectus recession. The average primary-position hypertropia after the first operation (n = 14) was 8 (range 0-15) PD. In the previously masked eye inferior oblique overaction averaged +1.8 and superior oblique underaction -1.1. The average interval from initial surgery to involvement of the contralateral side was 14.9 (range 0.2-52) weeks. The average primary-position hypertropia after the second operation (n = 10) was 1.6 (range 0-10) PD; follow-up averaged 15 (range 0-120) months. Postoperative alignment was excellent (within 6 PD of orthotropia) and binocular vision restored in 9 of the 10 patients. INTERPRETATION: Masked superior oblique palsy is difficult to detect before surgical correction of the initially manifest palsy. However, the possibility of an occult contralateral palsy should be considered in all patients undergoing surgery for unilateral SOP. Patients should be informed preoperatively of the possibility of this outcome. When the masked palsy becomes evident, a successful surgical outcome can usually be expected.     

Superior oblique muscle involvement in thyroid ophthalmopathy.

BACKGROUND: Rectus muscle involvement in thyroid ophthalmopathy is well documented. The inferior rectus is the most frequently involved, followed by the medial, superior, and infrequently the lateral rectus. This study reports involvement of the superior oblique muscle as a contributory cause of restrictive strabismus in patients with thyroid ophthalmopathy. METHODS: This is a retrospective review of four patients with known thyroid ophthalmopathy who presented with incomitant vertical strabismus, A-pattern, overdepression in adduction, underelevation in adduction, and incyclotorsion. All patients underwent preoperative orbital imaging. Two of the four patients had previous orbital decompressions. All patients underwent surgery on the SO muscle. RESULTS: Preoperative scans showed enlargement of one or both SO muscles in all patients and intraoperative forced duction testing revealed restriction to elevation in adduction in all cases. Preoperative A-pattern ranged from to 6 to 22 prism diopters. All subjects had preoperative incyclotorsion, ranging from 2 and 14 degrees. Improvement of the versions, hypertropia, and cyclotorsion followed surgical weakening procedures on the SO muscle. CONCLUSION: Thyroid ophthalmopathy may involve the SO muscle. Clinical manifestations include preoperative A-pattern strabismus, incyclotorsion, and restrictive limitation to elevation in adduction. Orbital imaging documents SO muscle enlargement. Awareness of SO involvement in thyroid ophthalmopathy assists the surgeon to develop a more precise surgical strategy to correct the hypotropia.     

Cyclotorsion during laser in situ keratomileusis

PURPOSE: To determine the magnitude of cyclotorsion during excimer laser ablation using a dynamic iris eye tracker. SETTING: Guy Hugh Chan Refractive Surgery Centre, Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong, China. METHODS: This retrospective study comprised 245 eyes (137 patients) that had laser in situ keratomileusis (LASIK) for myopia with or without astigmatism by the same surgeon. The magnitude of cyclotorsion during LASIK was recorded as the maximum, average, and minimum positions according to the angle of deviation displayed on the excimer laser computer screen. Measurements of cyclotorsion were performed during laser ablation. RESULTS: The mean total cyclotorsion was 2.181 degrees +/- 1.392 (SD) (range 0.0 to 13.3 degrees). The mean average position (AP) was +0.134 +/- 1.851 degrees (range -7.0 degrees [excyclotorsion] to +12.6 degrees [incyclotorsion]). Forty-five eyes (18.4%) had an AP greater than +/-2 degrees, and 168 eyes (68.6%) deviated from the zero position at the onset of laser ablation. The mean incyclotorsion was 2.136 +/- 1.440 degrees (78 eyes, 31.8%) and the mean excyclotorsion, 1.772 +/- 0.809 degrees (78 eyes, 31.8%). Eighty-six eyes (35.1%) had cyclotorsion in both directions (mixed cyclotorsion). The mean cyclotorsion was 2.670 +/- 1.588 degrees. Eight (3.3%) of the 109 patients having simultaneous bilateral LASIK had bilateral incyclotorsion or bilateral excyclotorsion. CONCLUSIONS: Cyclotorsion occurs before and during laser ablation. An active rotational eye tracker is fundamental to compensate for cyclotorsion and to enable greater precision in excimer laser ablation delivery.     

Strabismus surgery after macular translocation

PURPOSE: To present the application of various extraocular muscle surgery techniques to eliminate incyclotorsion induced by macular translocation. MATERIAL AND METHODS: Authors present surgical options and present the case of the patient in whom macular translocation was performed in Tübingen (Germany). Afterwards five strabismological surgeries were done: 2 in Tübingen and 3 in Department of Strabismology, Cracow District Eye Hospital. RESULTS: At the end of strabismological treatment the patient was free of disabling image tilt and diplopia. CONCLUSIONS: We present this case as an announcement of future challenge for strabologists if macular translocation surgeries will be performed in Poland.     

Fixation switch and diplopia after full macular translocation surgery.

PURPOSE: We sought to identify and evaluate treatment of patients who switched fixation to the poorer-seeing eye and complained of persistent diplopia 6 to 12 months after full macular translocation surgery (MT360) and extraocular muscle surgery. METHODS: All patients enrolled in a prospective study undergoing MT360 and extraocular muscle surgery were included. All patients had sensorimotor examinations. Visual acuity and fixation preference between 6 and 12 months after MT360 and extraocular muscle surgery were analyzed. RESULTS: Preoperative median visual acuity was 20/100 in operated vs 20/640 in fellow eyes; after MT360, the values were similar to the preoperative values (n = 67). After MT360 but before extraocular muscle surgery, all patients preferred the fellow eye for ambulation. Six to 12 months after MT360, 58 of 67 (86%) patients fixated with the better-seeing eye (52 operated vs 6 fellow eyes); 4/67 (6%) fixated with the operated eye despite its poorer or equal visual acuity; 5 of 67 (8%) fixated with the poorer-seeing fellow eye, all 5 of whom experienced diplopia (ie, fixation switch and diplopia). Treatment of diplopia included Fresnel prism, additional extraocular muscle surgery, and occlusion. CONCLUSIONS: Fixation switch to the poorer-seeing eye can occur after MT360, despite a successful visual outcome in the operated eye and the diplopia is difficult to treat.     

Correction of cyclovertical strabismus induced by limited macular translocation in a case of age-related macular degeneration

PURPOSE: To report a case of strabismus surgery performed to treat cyclovertical strabismus induced by limited macular translocation. METHODS: Case report. RESULTS: A 62-year-old man suffering with age-related macular degeneration and subfoveal choroidal neovascularization, RE, underwent limited macular translocation surgery. The fovea was rotated downward, and his visual acuity improved from 20/100 to 20/25 postoperatively. Cyclovertical diplopia persisted for 6 months after the operation. A Hess screen test revealed a pattern that simulated an underaction of the superior oblique muscle and inferior rectus muscle with an overaction of the ipsilateral inferior oblique muscle. To treat the diplopia, advancement of the superior oblique muscle tendon and resection of the ipsilateral inferior rectus muscle were performed. Binocular single vision with 140 seconds of arc for stereopsis was obtained. CONCLUSION: Cyclovertical strabismus after limited macular translocation is corrective with conventional surgery on the treated eye.     

Morphologic and angiographic assessment of the macula after macular translocation surgery with 360 degrees retinotomy

PURPOSE: To compare the optical coherence tomographic assessment of retinal thickness and the fluorescein angiographic appearance after macular translocation surgery for subfoveal choroidal neovascularization. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twenty-three consecutive eyes. INTERVENTION AND TESTING: Optical coherence tomography and fluorescein angiography were performed before and 6 to 15 months (mean +/- standard error [SE], 10.4+/-0.7) after macular translocation surgery with a 360 degrees retinotomy in 23 patients, ages 48 to 79 years, with age-related macular degeneration (12 eyes), polypoidal choroidal vasculopathy (2 eyes), and high myopia (9 eyes). The diameter of the choroidal neovascularizations ranged from 0.3 to 2.6 disc diameters (mean +/- SE, 1.2+/-0.2), and the angle of rotation of the retina ranged from 11 degrees to 45 degrees (mean +/- SE, 29.1+/-2.1 degrees ). RESULTS: The preoperative best-corrected visual acuity ranged from hand motions to 20/100, and the postoperative best-corrected visual acuity ranged from 20/667 to 20/25. Optical coherence tomography demonstrated a concave foveal configuration after surgery in all 23 eyes, with a mean foveal thickness of 150+/-11 micro m (mean +/- SE). Fluorescein angiography showed various degrees of fluorescein leakage with a pattern similar to cystoid macular edema in 16 of 23 eyes (70%). CONCLUSIONS: The newly located macula after macular translocation surgery with a 360 degrees retinotomy had cystoid macular edema on fluorescein angiography and normal macular configuration with normal thickness in optical coherence tomography.     

上斜肌麻痹患者斜视矫正术后眼球旋转状态的改变

目的 以眼底照相为客观定量检查方法,探讨单眼上斜肌麻痹患者斜视矫正术后眼球客观旋转状态的改变情况。方法 住院手术的40例（50只眼）单眼上斜肌麻痹的患者分别行患眼下斜肌切断术（15例15只眼）、患眼下斜肌部分切除术（15例15只眼）、患眼下斜肌切断+对侧眼下直肌后退术（10例20只眼）。于手术前和术后1、7、30、90 d行双眼眼底照相检查,使用绘图软件测量黄斑-视乳头夹角,定量记录客观旋转角度。并观察记录垂直斜视角度和眼球运动情况。同时对30例（60只眼）正常人行双眼眼底照相检查,记录眼球客观旋转角度。手术前后比较采用ANOVA即单因素重复测量资料方差分析方法,术后1、7、30、90d分别与术前比较采用平均值之间的多重比较q检验（SNK法）方法,不同术式间比较采用配对t检验方法。结果 30例正常人双眼眼底黄斑-视乳头夹角为右眼6.7°±2.5°,左眼5.9°±2.3°,双眼总和12.6°±4.3°,双眼间差异无统计学意义(t=1.29,P=0.20)。40例单眼上斜肌麻痹患者,术前双眼眼底黄斑-视乳头夹角为患眼14.3°±6.6°,对侧眼12.2°±4.8°,双眼总和26.5°±10.3°-双眼间差异无统计学意义(t=1.64,P=0.11)。上斜肌麻痹患者术前双眼总黄斑-视乳头夹角与正常人比较,差异有统计学意义。手术前后比较,双眼总黄斑-视乳头夹角术前为26.5°±10.3°-术后1、7、30及90d分别为11.7°±4.3°、11.9°±4.9°、13.5°±5.2°、15.9°±3.6°,组间比较差异有统计学意义(F =40.13-P＜0.01)。随术后时间延长眼球客观旋转角度又有逐渐增加的趋势,术后90d与术后1、7d对比差异有统计学意义。下斜肌切断手术组与下斜肌部分切除手术组相比,术眼手术前后黄斑-视乳头夹角改变量的差异无统计学意义(t =0.57,P=0.57)。患眼下斜肌切断+对侧眼下直肌减弱手术组,双眼间对比,手术前后黄斑-视乳头夹角改变量的差异无统计学意义(t=1.78,P=0.09)。结论 单眼上斜肌麻痹患者的眼底为外旋转位,并同时影响麻痹眼和非麻痹眼;减弱下斜肌或下直肌功能均可矫正眼球的外旋转状态,随时间延长,眼球的客观旋转角度有回退的趋势;下斜肌切断和下斜肌部分切除术矫正垂直旋转斜视的效果基本相同。     

V征斜视的临床特点和手术治疗的远期效果

目的探讨V征斜视的临床特点和手术方法及治疗效果。方法收集63例因V征斜视行下斜肌减弱术和常规水平直肌后退和(或)缩短术患者,回顾性总结和分析手术前、后的斜视度数,上、下注视眼位的斜视度数差,斜肌功能和双眼视功能状态。平均随访时间为8.2个月。结果62例(98.4%)患者合并双眼或单眼下斜肌功能亢进(+2或+3),行下斜肌减弱术和常规水平直肌后退和(或)缩短术;1例患者合并双眼下斜肌功能亢进(+1),仅行水平直肌后退缩短术。术前上、下注视眼位的斜视度数差为25.6△,随访末期为4.5△。48例外斜视V征患者术前水平斜视度数为(外斜)37.2△,随访末期为(内斜)3.4△,其中38例(79.2%)患者的斜视度数<±10△;15例内斜视V征患者术前水平斜视度数为50.6△,随访末期为(内斜)2.4△,其中11例(73.3%)患者的斜视度数<10△。术后21例(33.3%)患者恢复立体视功能。结论V征斜视患者多合并下斜肌功能亢进,减弱下斜肌功能可有效矫治V征斜视,常规斜视矫正方法可有效矫正水平斜视;术后患者立体视功能恢复情况良好。     

Diplopia after retinal detachment surgery.

Diplopia following retinal detachment usually responds to simple measures. Fifteen out of 311 cases developed diplopia lasting more than three months after conventional retinal detachment surgery. Binocular single vision was restored in 12 of the 15 cases (80%). The mean follow-up was four years. Diplopia was eliminated stepwise. If prisms were ineffective, our first surgical procedure was removal of the scleral buckle. If the retina was flat, we were prepared to remove the buckle early. When diplopia persisted after buckle removal, we proceeded to strabismus surgery. Our most consistent results followed strabismus surgery on the untreated eye. Prisms alone restored binocular single vision in six patients (40%), one of whom preferred to adopt a compensatory head posture. Removal of the scleral buckle restored binocular single vision in three patients (20%), with the help of a prism in one case and a compensatory head posture in another. Binocular single vision was restored after buckle removal and strabismus surgery in three further patients (20%), one requiring a prism in addition. Binocular single vision was not restored in three patients (20%).     

Changes in focal macular ERGs after macular translocation surgery with 360 degrees retinotomy

PURPOSE: To evaluate the short- and long-term changes of focal macular electroretinograms (fmERGs) after macular translocation with 360 degrees retinotomy. METHODS: This was a retrospective study. fmERGs were recorded in 19 eyes of 19 consecutive patients who underwent macular translocation with 360 degrees retinotomy for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD; 17 eyes) or polypoidal choroidal vasculopathy (2 eyes). The changes in the fmERGs, recorded before, shortly after (6-12 months; mean 8.3 months), and more than 18 months (18-30 months; mean 22.4 months) after surgery from 12 eyes, were analyzed. A 15 degrees stimulus centered on the fovea was used to elicit the fmERGs. RESULTS: The mean logarithm of minimum angle of resolution (logMAR) was 1.06 +/- 0.07 (20/230) before surgery, 0.78 +/- 0.08 (20/121) early after surgery (n = 19), and 0.64 +/- 0.07 (20/87) late after surgery (n = 12). These improvements in visual acuity were significant (P = 0.0074, P = 0.0050, respectively). Before surgery, the amplitudes of all components of the fmERGs were markedly reduced in all eyes. The mean b-wave amplitude in 17 AMD eyes recorded early after surgery was significantly larger (P = 0.0262), and the mean a-wave amplitude was also increased but not significantly (P = 0.1180). The mean amplitudes of the a- and b-waves in 10 AMD eyes recorded after 18 months were significantly larger than those before the surgery (P = 0.0218, and P = 0.0284). The mean implicit time of the b-wave in 17 AMD eyes decreased early after surgery, and a further decrease was detected at the later testing time. CONCLUSIONS: These results indicate that macular function is partially recoverable after macular translocation in some patients.     

A Comparison of Visual Field and Optic Disc Appearance Depending on the Peak Intraocular Pressure in Patients with Normal-tension Glaucoma

Purpose To review the outcome of surgery for strabismus due to ethmoid sinus surgery.Cases and Methods The series comprised 13 cases, 1 of inferior rectus paresis, 1 of superior oblique paresis, 6 of medial rectus paresis, and 5 of medial rectus muscle palsy due to third nerve palsy. In the cases of paresis of the rectus muscle, resection of the rectus muscles was mainly performed. In the cases of palsy of the rectus muscle, transposition of the extraocular muscle with simultaneous recession of the lateral rectus muscle was performed. The major aim of surgery was to bring both eyes into alignment and to eliminate diplopia in the primary position.Results The mean preoperative horizontal deviation of 18.1 degrees of exotropia in the paresis cases was reduced to 1.4 degrees of exotropia after surgery. The mean preoperative vertical deviation of 3.8 degrees of hypertropia was reduced to 1.4 degrees of hypertropia postoperatively. The mean preoperative horizontal deviation of 35.6 degrees of exotropia in the palsy cases was reduced to 9.4 degrees of exotropia after surgery. The mean preoperative vertical deviation of 2.0 degrees of hypertropia was increased to 2.6 degrees of hypertropia postoperatively. Postoperatively, diplopia was absent in 11 cases with a slightly compensatory head posture.Conclusions Surgery for strabismus due to sinus surgery induces improvements in eye position and diplopia. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:425–432, 2003)     

Surgical management of monocular torsion and head tilt after macular translocation

BACKGROUND: Macular translocation following 360 degrees retinotomy is a possible surgical treatment of patients with age-related macular degeneration. However, it produces important subjective disturbances with diplopia and head tilt due to cyclodeviation. Complex surgical procedures involving both oblique muscles and two or four recti have been advocated. PATIENTS AND METHODS: Four symptomatic patients with macular translocation underwent counter-rotating surgery by very large recession and advancement of both oblique muscles of the affected eye. Preoperative subjective cyclo-deviations varied between 25 degrees and 60 degrees and head tilt ranged between 25 degrees and 45 degrees . RESULTS: Reduction of cyclodeviation ranged between 22 degrees ant 30 degrees in our four patients. Two patients showed residual cyclo-deviations of 3 degrees and 7 degrees with complete recovery of the head tilt. The remaining two patients showed significant subjective improvements and important reductions of head tilt, in spite of a large residual cyclodeviation. No patient exhibited binocular vision. CONCLUSION: Without jeopardizing the anterior segment blood supply of these elderly patients, a combined surgical procedure on both oblique muscles has shown to be sufficiently effective in reducing subjective cyclodeviation and head tilt in four cases of macular translocation. A complete counter-rotation does not seem to be required to achieve an important improvement of subjective symptoms. This may be due to sensorial adaptation.