Delayed Conjunctival Closure in Adjustable Strabismus Surgery

Adjustable suture strabismus surgery has proved to be a significant aid in handling difficult strabismus cases, and various methods of conjunctival closure have been discussed. A new method of conjunctival closure, enabling direct visualization and manipulation of the muscle with minimal tissue drag during adjustment, is described. The conjunctiva can be fully closed over the knot after adjustment, providing increased patient comfort and a better cosmetic result.     

Accommodative stimulus/response function in human amblyopia

Three parameters are essential to describe static accommodative behavior in a comprehensive, quantitative manner: the slope of the stimulus/response curve, the depth of focus, and the tonic response. These parameters were obtained in amblyopes, former amblyopes, strabismics without amblyopia, and normals. Results showed that the accommodative response in the amblyopic eye was characterized by a reduction in the slope of the stimulus/response curve and increased depth of focus. Similar abnormalities but of lesser magnitude were found in the non-dominant eye of some former amblyopes and some strabismics without amblyopia. Orthoptic therapy always increased the slope of the stimulus/response curve in the amblyopic eye. We believe that the reduced accommodative responses found in amblyopic eyes reflect a primary sensory loss over the central retinal region that occurs as a result of prolonged, early, abnormal visual experience associated with the presence of strabismus and/or anisometropia.     

Ophthalmological examination of the infant. Developmental aspects

In recent years, the ophthalmic examination of infants has been of increasing interest to both clinicians and vision researchers. Clinicians have documented a greater risk of retinopathy, strabismus and amblyopia in premature infants, especially those of low birthweight. In addition to the external and retinal examination of the infant eye, a number of clinical tests can help the ophthalmologist to detect visual dysfunction through the evaluation of pupillary responses and ocular motility. Recently, the development of objective techniques (optokinetic nystagmus, forced choice preferential looking, and visually evoked potentials) have not only aided in the detection of ophthalmic disorders in infants; they have contributed to useful definitions of “normal” vision at various ages and to the understanding of factors that influence the pre- and post-gestational development of visual function.     

THE CAT AS A MODEL FOR VISUAL DEPRIVATION

Both behavioural and neurophysiological changes can be observed in cats that have experienced interference with their normal visual environment. This visual deprivation may result from alterations to the path of light forming the normal image on the retina, and includes changes that cause the image to fall on an inappropriate part of the retina so that normal binocular interactions are affected. While some neurophysiological changes can be observed at the level of the lateral geniculate nucleus they become more prominent as information reaches the visual cortex, where cells commonly receive neural excitation from both eyes and require the information to come from corresponding parts of the two retinas and that the stimulus should have appropriate orientation and direction of movement. Many of the observations of deprivation in animals have clear parallels in the human environment.     

Oral clonidine premedication does not reduce postoperative vomiting in children undergoing strabismus surgery

BACKGROUND: We evaluated the effect of oral clonidine on postoperative vomiting (POV) in children undergoing strabismus surgery. METHODS: Eighty ASA physical status I children aged 3-12 years were randomly assigned to one of two groups in a double-blinded manner. One hour before surgery, each patient in the clonidine group (n=40) received clonidine 4 micro g kg-1 in apple juice 0.2 ml kg-1, and each of the controls (n=40) received apple juice 0.2 ml kg-1 only. The protocol for general anesthesia was propofol-sevoflurane in N2O/O2. A paracetamol suppository was administered in each case to prevent postoperative pain. Patient responses during 0-48 h after anesthesia were recorded as complete (no POV, no antiemetic rescue required), retching, vomiting, or rescue antiemetic. RESULTS: There were no significant differences between the clonidine and control groups regarding the number of patients with complete response (21 vs. 18, respectively) retching (10 vs. 14, respectively), vomiting (19 vs. 22, respectively), or rescue antiemetic (9 vs. 12, respectively) during the first 48 h. CONCLUSION: Oral premedication with clonidine 4 micro g kg-1 did not reduce the rate of POV in the children undergoing strabismus surgery.     

病人自控镇静镇痛在玻璃体和斜视手术的应用研究

[目的]探讨病人自控镇静镇痛（PCSA）在玻璃体和斜视手术中应用。[方法]玻璃体切割术和斜视矫正术病人共68例,随机分入舒芬太尼联合异丙酚PCSA组（P组）和单纯局麻组（C组）。每组34例,其中两类手术各占17例。P组局麻并以PCSA辅助。术中观察收缩压、心率、呼吸、镇静评分、病人合作度评分、满意度评分、疼痛评分及术中眼心反射和术后恶心呕吐等不良反应。[结果]与基础值比较,P组仅术中10min的收缩压、心率升高;C组术中各时点均显著升高;P组呼吸频率下降。术中P组镇静评分、合作度和满意度评分显著高于C组,而疼痛评分、躁动、呻吟发生率显著低于C组。两组眼心反射和恶心呕吐发生率无差异。术后4h疼痛评分P组显著低于C组,术后8h两组疼痛评分无差异。[结论]舒芬太尼联合异丙酚PCSA应用于玻璃体及斜视手术能提高病人术中术后镇痛的满意度,安全有效。     

Orbital Approach for Retrieval of Transected Extraocular Muscles

Transection of an extraocular muscle can occur from orbital and facial trauma, or as a complication of surgery. The injury can occur either near the muscle insertion or in the muscle belly. Identification of the proximal end of the muscle in the orbit may be difficult, especially if the transection occurs a farther distance from the insertion, and, in these cases, the muscle is often considered lost. We present two patients who suffered from traumatic transections of an extraocular muscle more than 10 mm from the insertion. Both patients underwent transconjunctival orbitotomy to retrieve and secure the severed extraocular muscle. Both patients achieved good primary gaze alignment postoperatively. Preoperative imaging should be considered in cases of traumatic extraocular muscle transection.     

水平斜视的美容矫正

目的：观察直肌超长量后退及直肌3根缝线固定矫正水平斜视的美容效果。方法：对68例以美容为首要目的的水平共动性斜视患者采用直肌超长量后退，拮抗肌折叠或适量切除，每条直肌各做3根套环缝线、先固定中间缝线的方法矫正。结果：68例中获得随访者46例，随访时间3个月－12个月，术后眼位近期（1周）正位率82．6％，远期（≥6周）正位率80．4％，无继发垂直性斜视发生。结论：直肌超长量后退及每条直肌3根缝线、先固定中间缝线的方法是矫正水平共动性斜视，特别是大角度斜视的安全、有效的方法。     

Topical amethocaine in strabismus surgery

A randomized study was performed to assess the effect of topical 1% amethocaine hydrochloride on postoperative analgesia requirements after strabismus surgery. Forty children scheduled for elective operation were allocated randomly to receive either topical amethocaine or normal saline. Postoperative analgesia was evaluated with the use of a four-point assessment score and analgesic requirements. The topical amethocaine provided significantly better postoperative analgesia (p less than 0.001) as measured by both the assessment score and the postoperative analgesia requirement.