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Query: UMLS:C0038379 (strabismus)
 9,317 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

1) Cases of strabismus combined with abnormalities in ocular movement were divided into three groups: paralytic nonconcomitant strabismus, special forms of strabismus, and paralytic concomitant strabismus. 977 cases of surgery for paralytic nonconcomitant strabismus were analyzed. 2) 109 cases of surgery for paralytic esotropia due to abducens palsy were performed. In cases of complete paralysis, a transposition of the vertical rectus muscle was indicated. In cases of incomplete paralysis, a resection of the lateral rectus muscle was indicated. On the basis of these indications, the same results could be achieved, and when a recession of the medial rectus muscle was concurrently performed the results were improved. 3) In oculomotor palsy, 138 cases of surgery for paralytic exotropia were performed. In cases of complete paralysis, a transposition of the superior oblique muscle was indicated. In cases of incomplete paralysis, a resection of the medial rectus muscle was indicated. On the basis of these indications, the same results could be achieved, and when a recession of the lateral rectus muscle was concurrently performed the results were improved. 4) 570 cases of surgery for superior oblique muscle palsy were performed. In cases of vertical deviation, a weakening operation on the inferior oblique muscle, the superior rectus muscle of the affected eye, and the inferior rectus muscle of the sound eye were indicated. In cases of torsional deviation, good results were obtained through an advancement of the anterior part of the superior oblique muscle and a resection of the superior oblique muscle. 5) Statistics concerning cure based on the standards for cure employed by the Japanese Association of Strabismus and Amblyopia, or from the point of view of cosmetic cure were: 85% for paralytic esotropia and superior oblique muscle palsy, 82% satisfactory for incomplete paralysis of the oculomotor nerve within paralytic exotropia, and 61% relatively unsatisfactory for complete paralysis of the oculomotor nerve within paralytic exotropia. 6) The results of 216 cases examined after period of four years or longer were: cases where a one-month postoperative cure or cosmetic cure was maintained over this period were 90% of superior oblique muscle palsy cases, 79% of paralytic esotropia, and 59% of paralytic exotropia. Paralytic exotropia showed poor results. The surgical methods were muscle transposition in cases of horizontal muscle surgery and surgery of the oblique muscles in cases of vertical muscle surgery. 7) Through the Turn-Amplitude Analysis of the amounts of EMG interference patterns in the extraocular muscle, neuropathy was classified as either complete or incomplete.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Treatment of paralytic strabismus]. 783 64

We reviewed records from 428 consecutive patients with severe Graves' ophthalmopathy to determine early and late results after transantral orbital decompression. Optic neuropathy was present in 217 (50.7%) patients. Post-operatively, 402 (89%) of 453 eyes with preoperative visual acuity worse than 20/20 improved or remained the same. Visual field scotomas improved or resolved in 245 (91%) of 269 eyes tested pre- and postoperatively. Preoperative papilledema resolved or improved in 99 (94%) of 105 eyes, and preoperative exposure keratitis improved or resolved in 178 (92%) of 195 eyes. Average proptosis reduction was 4.7 mm. Postoperatively, new diplopia developed in 74 (64%) of 116 patients who had no diplopia before orbital decompression, although 300 patients ultimately had strabismus surgery. At late follow-up (N = 293 patients), 226 (77%) had single vision and 44 (15%) had correction with prism. Complications included sinusitis (18 patients), lower eyelid entropion (38 patients), numb lip (23 patients), cerebrospinal fluid leaks (15 patients), and one frontal lobe hematoma (one patient). The average duration of follow-up was 8.7 years. Transantral orbital decompression effectively reduces proptosis and usually corrects optic neuropathy. In other circumstances, the benefits achieved and the side effects incurred must be carefully balanced for each patient before transantral orbital decompression is considered.
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PMID:Results of transantral orbital decompression in 428 patients with severe Graves' ophthalmopathy. 823 12

Although systemic steroids or orbital radiotherapy are effective in limiting the inflammatory response in thyroid eye disease (TED), there are reports of over 70% of treated patients requiring subsequent rehabilitative surgery: either orbital decompression or strabismus correction. This study investigated whether combined immunosuppression with primary orbital radiotherapy together with azathioprine and low-dose prednisolone, applied early in the active disease state, was more effective in treating TED. Forty consecutive patients with active TED were recruited. Orbital MRI (STIR sequence) was used to assess disease activity. Median duration of symptoms was 1.0 year. Subjects were treated with bilateral orbital radiotherapy (20 Gy in 10 fractions) and oral prednisolone and azathioprine. Pre- and post-treatment activity was measured clinically, including uniocular field of fixation, Mourits score and total eye score, until TED became inactive off all treatment. Before treatment, 15 subjects had signs of dysthyroid optic neuropathy, 35 had significant motility restriction and 38 had marked soft tissue signs. On average TED became inactive after 1.2 years (SD 0.7) of immunosuppression, and treatment was well tolerated. One patient required subsequent cosmetic orbital decompression, 6 had successful strabismus surgery and 13 required minor cosmetic lid surgery. Compared with previously reported treatment regimes we think that combined orbital radiotherapy and medical immunosuppression is far more effective than either treatment alone in the management of active TED, and led to fewer side effects of high-dose steroids. In particular there was more than a four-fold reduction in the requirement for orbital decompression and strabismus surgery.
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PMID:Combined radiotherapy and medical immunosuppression in the management of thyroid eye disease. 947 1

Surgical treatment of thyroid-related orbitopathy can be accomplished by transorbital or endoscopic techniques. Transorbital surgery has advantages in the orbital floor and lateral wall, and endoscopic decompression is best suited to the medial orbital wall. We describe a retrospective review of 16 orbits (10 patients) treated with surgery, combining endoscopic decompression of the medial wall and a transorbital approach to the floor and lateral wall. Follow-up averaged 20.8 months. Vision and field defects improved dramatically in compressive optic neuropathy cases. Hertel measurements improved, on average, 4.9 mm. Two patients with severe preoperative diplopia required strabismus surgery after decompression. Combined-approach decompression is a safe and efficacious operation with conceptual advantages over current surgical techniques.
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PMID:Combined-approach orbital decompression for thyroid-related orbitopathy. 1022 54

Thyroid ophthalmopathy is an inflammatory disorder of the extraocular muscles, orbital fat and orbital connective tissue that is most commonly seen in patients with Graves' hyperthyroidism. Inflammation is accompanied by deposition of extracellular matrix components, in particular glycosaminoglycans. The increase in the volume of the orbital contents may lead to periorbital swelling, extraocular muscle dysfunction, disfiguring proptosis, exposure keratitis, increased intraocular pressure and optic nerve compression. In many cases, surgical treatment is necessary for the rehabilitation of patients. In this report, we present a series of patients to illustrate relevant procedures and the results of surgical treatment in patients with thyroid ophthalmopathy. The records of all patients (66) with thyroid ophthalmopathy hospitalized in the Department of Ophthalmology, Haukeland University Hospital 1 April 1994-31 March 1998 were retrospectively evaluated. Orbital decompressions were performed in 43 patients (in 17 for compressive optic neuropathy), squint surgery in 13 patients, correction of eyelid retraction in 20 patients, and removal of excessive skin and fat from the eyelids in 11 patients. Average reduction of proptosis was 4 mm after lateral wall resection, and 6 mm after combined medial and lateral wall resection. Visual acuity improved in patients with compressive optic neuropathy to 6/6 or better in 18/20 eyes (postoperative data were not available for all patients), while that of the remaining two eyes was 6/9 and 6/24, respectively. Squint surgery was successful (no diplopia in primary or reading position) in eight patients after one procedure, and in four after two procedures. One patient has been scheduled for a third procedure due to a severe esotropia. In patients with thyroid ophthalmopathy, suboptimal treatment of the thyroid disorder may worsen the ophthalmopathy. 16 patients had their medication adjusted, ten were referred for thyroid surgery, and one for treatment with radioiodine. Treatment of patients with thyroid ophthalmopathy is a therapeutic challenge requiring close collaboration between different specialists. In severe cases, several surgical procedures may be needed. The complication rate is low, however, and for most patients the functional as well as the aesthetic situation is greatly improved.
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PMID:[Surgical treatment of endocrine ophthalmopathy]. 1038 May 88

This review focuses on neuro-ophthalmic disorders caused by trauma. Most articles discussed were published after 1995. The review is divided into sections according to the anatomical sites that can be affected by trauma and lead to neuro-ophthalmic symptoms. The topics are the oculomotor nerves and the facial nerve, the cavernous sinus, the orbit, the optic nerve, and the brain. Treatment options are discussed, including strabismus surgery, orbital reconstruction, and medical as well as surgical treatment of traumatic optic neuropathy.
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PMID:Neuro-ophthalmology of trauma. 1038 34

Visual dysfunction, including visual loss and diplopia, may occur in association with ocular surgery. Strabismus may be the most common abnormal eye movement seen as a complication of local anesthesia. Local anesthesia also may cause direct and indirect traumatic optic neuropathy. Vitrectomy is associated with visual-field loss from direct manipulation of the nerve fiber layer during suctioning of the vitreous or by direct compression of intraocular gas. Trabeculectomy may be complicated by visual-field loss. Patients may be at higher risk if their eye is hypotonous after surgery, but the duration or severity of hypotony that places the eye at risk is unknown. The only neuroophthalmic complication directly related to cataract surgery itself is AION. Complications of ONSD include motility disorders, pupillary dysfunction, and vascular compromise. Neuroophthalmic complications are uncommon after blepharoplasty. They include ocular motility disorders, transient pupil dilation, and vision loss.
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PMID:Neuroophthalmological complications of ocular surgery. 1071 17

In order to demonstrate the safety and efficacy of transnasal orbital decompression for malignant Graves' ophthalmopathy, we carried out a retrospective chart review and clinical follow-up examination of 78 consecutive patients who were operated on for compressive optic neuropathy (CON) with loss of visual acuity or visual field defects. The intervention - strictly transnasal, endoscopically controlled, bilateral decompression of the medial and inferomedial wall of the orbit - was performed when medical and radiation therapy had failed. A total of 145 endonasal decompressions were performed on 78 patients (63 female, 15 male, 52. 2 +/- 10.5 yrs.) over 9 years. Of these, 65 were operated bilaterally, 15 required only unilateral decompression; 4 had repeated surgery. Visual acuity increased from an average of 0.50 +/- 0.27 (range, 0.01 - 1.25) to 0.75 +/- 0.21 (range, 0.01 - 1.25). Proptosis decreased by an average of 3.94 +/- 2.73 mm (range, -1.0 - 11.0 mm), from a mean preoperative Hertel measurement of 22.19 +/- 3. 13 mm (range, 15 - 34 mm) to a mean postoperative Hertel measurement of 18.3 +/- 2.65 mm (range, 10 - 26 mm). Ocular motility was corrected by recession of the medial rectus muscle in 58 cases, in 26 cases immediately after decompression in the same surgical session. The transnasal orbital decompression procedure improved vision, decreased proptosis in a range comparable to more invasive techniques and had favorable cosmetic results without additional disfiguring by scars. Post-decompression strabismus was successfully managed by recession of both medial orbital muscles in the same surgical session.
Strabismus 2000 Jun
PMID:Preliminary report: long-term results of transnasal orbital decompression in malignant Graves' ophthalmopathy. 1098 Jun 92

Ophthalmopathy developing in the course of Graves-Basedow disease, although known for years, still causes controversy both about classification of eye symptoms, treatment modalities and terminology. The paper gives an update view on the etiopathogenesis of ophthalmopathy, terminology, classification and dynamics of clinical symptoms, as well as it presents the methods for treating its most important symptoms. Particular attention was focused on surgical treatment of lid retraction and strabismus, as well as on the present requirements in pharmacological and surgical treatment of the most serious complication of ophthalmopathy i.e. optic neuropathy. The role of an ophthalmologist in the process of diagnosis and monitoring of Graves' ophthalmopathy was also emphasised.
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PMID:[Graves-Basedow ophthalmopathy in light of current views]. 1110 61

An euthyroid patient was referred for compressive optic neuropathy in Graves' disease. Under prednisone therapy the right and left visual acuities were 1.0 and 0.4, with a profound decrease in color vision on the left. Bilateral anterior orbital decompressions were performed. When prednisone was withdrawn postoperatively, the visual acuity of the right eye dropped to 0.32 with bilateral complete failure on the Ishihara color test. A biopsy of the inferior oblique muscle of the left eye confirmed Graves' disease and additional transantral decompression of the right orbital apex was performed. Under intravenous methylprednisolone therapy, the visual acuity dropped postoperatively to 0.2 and 0.4, respectively. 15 U botulinum toxin were given by retrobulbar injection between the inferior and lateral rectus muscles. Four days later the patient called and said that the visual acuity in the right eye had improved tremendously. Two weeks after the injection the visual acuity was 0.7 in both eyes, although prednisone had been reduced to 20 mg by that time. The convergent strabismus had increased but the already severely restricted motility of the right eye had been little affected by the retrobulbar injection, and adduction not at all. Orbital CT-scan showed thinning of the inferior and lateral rectus muscles, but not of the medial rectus.
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PMID:Botulinum toxin as adjunct for refractory compressive optic neuropathy in Graves' disease. 1204 25


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