Reaktionszeitmessungen bei Amblyopie

Zusammenfassung Die Zeit zwischen der Darbietung eines Fixierpunktes und dem Beginn einer darauf zielenden Augenbewegung, dieReaktionszeit, ist gewöhnlich bei Reizdarbietung am amblyopischen Auge länger als bei der Prüfung des vollsichtigen Auges. Diese zeitliche Differenz wird noch deutlicher, wenn der Reiz nicht in der Netzhautperipherie dargeboten und mit einer Augenbewegung beantwortet wird, sondern wenn auf eine Reizdarbietung im Netzhautzentrum als Reizantwort der Druck auf eine Morsetaste erfolgt. Die zeitliche Verzögerung erfolgt wahrscheinlich im sensorischen Anteil der Bahn, und zwar entweder in der Netzhaut oder in der Hirnrinde.Mit 6 Textabbildungen     

Dichoptisches Training bei Amblyopie

Dichoptic training is a promising new therapeutic approach to amblyopia, which employs simultaneous and separate stimulation of both eyes (thus dichoptic). The contrast for the good eye is reduced thus aiming at a balance with the amblyopic eye. In contrast to monocular patching, binocular vision is trained by video game tasks that can only be solved binocularly. To date the average gain in visual acuity achieved in currently available studies is only 0.20 ± 0.07 logMAR and is not significantly better than competing treatment options. This article explains the basic approach of dichoptic training, summarizes pertinent studies, names unsolved problems and closes with a personal critical assessment.     

Genetische Untersuchungen bei kongenitaler Katarakt

Bilateral congenital cataract is genetic in at least 25% of cases. In contrast, unilateral congenital cataract is usually sporadic. Genetic heterogeneity is significant with the involvement of more than 30 genes having been identified to date. Phenotypes are defined by the location and morphology of the lens opacities. Mutations in the same gene may result in different phenotypes (clinical heterogeneity), and mutations in different genes may be associated with similar phenotypes (genetic heterogeneity). The mode of inheritance is mostly autosomal dominant but autosomal recessive and X-linked modes also occur. Expressivity may be variable and penetrance reduced. In X-linked cataract, carriers may show carrier signs. A precise pedigree analysis and a clinical examination of further family members are mandatory for correct genetic counselling. Metabolic cataract may be diagnosed biochemically. Molecular genetic analysis is not offered routinely to date with the exemption of a few genes.     

Ueber die Amblyopie bei Nierenleiden mit Herzhypertrophie

Ohne Zusammenfassung     

Lagophthalmus mit Oberlidektropium bei kongenitaler Ichthyosis

This report concerns the case of a 10-year-old female patient with congenital ichthyosis who developed bilateral ectropion of the upper eyelids resulting in massive ocular surface alterations due to lagophthalmos. A complex surgical approach with partial excision, tarsal strip refixation and a free skin graft led to normalization of the eyelid positioning and healing of the ocular surface.     

Untersuchungen zur Operationsdosierung bei Strabismus convergens

Zusammenfassung Bei 252 Patienten mit Strabismus concomitans convergens wurde retrospektiv das Operationsverfahren der kombinierten Internusrücklagerung und Externusresektion untersucht. Es wurde die Schielwinkelreduktion mit der Gesamt- und der Einzeldosierung verglichen. Die Internusrücklagerung hat langfristig eine 3fach stärkere Wirkung als die Externusresektion. Eine Formel zur Berechnung der Schielwinkelreduktion wurde angegeben. Bei 61,5% der Patienten wurde Parallelstand der Augen und Restwinkel bis 10 pdpt erreicht, wobei sich die Gesamtergebnisse der ersten und der zweiten postoperativen Untersuchung nur geringfügig voneinander unterschieden.

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Results of surgical treatment in strabismus convergens

Summary In 252 patients with strabismus concomitans convergens the surgical method of the combined medial rectus recession and lateral rectus resection (Fig. 1) was studied retrospectively. The reduction of the deviation was compared with the added displacement of both muscles (Figs. 2 and 3) or the displacement of one single muscles (Table 1 and 2). Fig. 4 shows the relation between the recession-resection and the reduction of the deviation. A formula for this reduction (Z) is given: Z=6.7 x recession (in mm) +2.2 x resection (in mm) –8.1. In long the recession is 3 times more effective than the resection. In 61.5% of the patients the eyes stood parallel after surgery or a residual deviation up to 5° was achieved. There was a little difference in the total results of the first (1 week) and the second (6 months) postoperative control. Major differences occurred when comparing single data.

     

Über das nasale Gesichtsfeld bei Strabismus fixus divergens

Zusammenfassung Bei einem 75jährigen Patienten mit kongenitalem extremen Strabismus fixus divergens fiel ein ungewöhnlich großes (im horizontalen Meridian bis 80° reichendes) nasales Gesichtsfeld auf.Diese Beobachtung spricht dafür, daß die physiologische Begrenzung des nasalen Gesichtsfeldes auf der von Kindheit an bestehenden Ausschaltung der nasalen Gesichtsfeldperipherie durch die Blendenwirkung der Nase beruht. Man könnte von einer partiellen Erblindung ex anopsia sprechen.Ein extremer Strabismus fixus divergens zusammen mit einem Divergenznystagmus ist unseres Wissens noch nicht beschrieben worden.

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On the nasal visual field in a patient with strabismus fixus divergens

Summary A man of 75 years with a congenital extreme strabismus fixus divergens had an extraordinary enlarged nasal visual field. It was extended to 80°.This observation tends to indicate that the physiologic border of the nasal visual field develops because of an exclusion of the nasal periphery of the visual field—by the screen effect of the nose since childhood. One could call this a partial blindness ex anopsia.To our knowledge an extreme strabismus fixus divergens together with a divergent nystagmus has never been described before.

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Mit Unterstützung des SPB 70. Für die Mithilfe bei der elektronystagmographischen Untersuchung danken wir der MTA Frl. Ruth Löhr.     

The Prevalence of Ptosis and Its Association with Amblyopia and Strabismus in 7-Year-Old Schoolchildren in Iran

Abstract

Purpose: To determine the prevalence of ptosis (congenital/acquired) in Iranian children aged 7 years and its relationship with amblyopia and strabismus.

Methods: Eight Iranian cities were selected for this cross-sectional study using multistage randomized cluster sampling. A number of primary schools were randomly selected in each city. All grade 1 students in each selected primary school underwent optometric examinations including the measurement of uncorrected and corrected visual acuity, cover test, and cycloplegic and non-cycloplegic refraction.

Results: Of 4614 selected students, 4106 students participated in the study (response rate?=?89%). The prevalence of ptosis (congenital/acquired) was 1.41% (95% CI 1–1.83); 0.49% (95% CI 0.26–0.72) and 0.93% (95% CI 0.59–1.26) had unilateral and bilateral ptosis, respectively. The prevalence of ptosis had no significant correlation with sex (p?=?0.810, OR?=?1.07, 95% CI 0.59–1.97). The prevalence of amblyopia was 48.28% and 0.89% in students with and without ptosis, respectively. The prevalence of tropia was significantly higher in cases with bilateral ptosis (p?<?0.001). The mean cylinder error was 1.63?±?1.72 and 0.44?±?0.60 in ptotic and non-ptotic eyes, respectively (p?<?0.001). With-the-rule (WTR) astigmatism was significantly more prevalent in students with ptosis.

Conclusion: We report the prevalence of ptosis (congenital/acquired) in children in Iran and the Middle East region for the first time. Amblyopia was considerably more prevalent in ptotic patients. We found a significant correlation between ptosis and tropia. Astigmatism, especially WTR stigmatism, was more prevalent in children with ptosis.     

Dosis-Wirkungs-Beziehung bei Revisionsoperation des konsekutiven Strabismus divergens im Erwachsenenalter

BACKGROUND: The aim of this study was to establish a dose-effect relationship between the reduction of the angle of deviation and the millimeters of the reoperation performed in patients with consecutive exotropia.PATIENTS AND METHODS: A total of 46 patients who had undergone reoperation for consecutive exotropia (group 1: advancement of the former recessed medial rectus muscle and group 2: additional rececession of the lateral rectus muscle) were reexamined.RESULTS: The dose-effect relationship was 2 degrees /mm in group 1 and1.6 degrees /mm far distance and 1.8 degrees /mm near in group 2. Within the first 4 months after the reoperation we found an exodrift of up to 6 degrees , which remained stable; 98% of our patients reported that their quality of life had improved.CONCLUSION: In cases of consecutive exotropia we consider the postoperative exdodrift in the planing of our reoperation. During the ensuing years patients can expect stability of the results achieved by the reoperation.     

Die Amblyopie und ihre Behandlung

Besteht eine Kombination von organsicher und funktioneller Ursache, so spricht man von einer gemischten oder kombinierten Amblyopie. Der Beweis der funktionellen Natur der Amblyopie ist erbracht, wenn die Visusverminderung durch Okklusion geheilt oder gebessert werden kann. Natürlich mu? man bei jeder Amblyopie nach Trübungen der brechenden Medien und Ver?nderungen des Fundus suchen (bes. Hypoplasie der Fovea oder der Papille). Nur noch selten wird der Ausdruck Amblyopie im Zusammenhang mit einer organisch bedingen Visusverminderung verwendet, so z.B. als Alkohol-Tabak-Amblyopie, Chinin-Amblyopie, usw.