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

The orbit in Graves disease undergoes expansion in soft tissue content as a result of the infiltration of orbital fat, extraocular muscles, and the lacrimal gland. Compression of the intraorbital contents leads to disorders of the lid-corneal interface, keratopathy, motility disturbances, exophthalmos, and optic neuropathy. Orbital decompression has traditionally been reserved for those patients with unremitting optic neuropathy. This article provides a historical review of orbital decompression, as well as a review of the evolution of surgical approaches toward both soft tissue and bony decompression. Recent trends in surgical management include fat decompression, more extensive posterior sculpting of the lateral wall, and direct approaches to the medial wall. Preoperative predictors of diplopia and hypoglobus are addressed, as are the various techniques that are employed to limit new postoperative strabismus. The roles of endoscopy and combined surgical techniques are also reviewed. Expanded indications for decompression and its effect on increased intraocular pressure are discussed as well.
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PMID:Orbital decompression: current concepts. 1221 62

In the past few years, there have been many changes in ophthalmic anaesthesia. Application of drugs in general anaesthesia with excellent controllability enhances patient safety and allows a more efficient OR-management. Regional anaesthesia is gaining widespread use for ophthalmic surgery, especially topical anaesthesia for cataract surgery. Patients for ophthalmic surgery concomitantly often display high age and a high level of co-morbidity and, therefore, belong to the anaesthesiological risk groups ASA III-IV. Life-threatening adverse events including cardiovascular depression are associated with general and regional anaesthesia. Intervention by anaesthesiologists is frequently required for treatment of hypertension or dysrhythmias, and sedation. Thus, monitored anaesthesia care ("standby") is justified. Drugs applied for regional and general anaesthesia may change intraocular pressure. There are a lot of publications about the impact of anaesthesia on intraocular pressure (IOD), however, few on the effects of anaesthesia on pulsatile ocular blood flow. it has to be kept in mind that the effects of anaesthesia on intra-ocular pressure and pulsatile ocular blood flow may diverge. To avoid an increase of the IOD, especially during anaesthesia induction, drugs, such as succinylcholin, rocuronium and opiates, in particular remifentanil, can be applied. In addition, the use of the laryngeal mask may be advantageous compared to general anaesthesia associated with laryngoscopic tracheal intubation. The management of patients treated with anticoagulants and antiplatelet agents, has to be taken on the balance of risks. There are risks not only in continuing therapy, but also in discontinuing it perioperatively. Postoperative nausea and vomiting (PONV) remains a distressing and common problem after strabismus repair in particular in children. The incidence of PONV depends on the type of ophthalmic surgery and drugs applied. To reduce PONV in ophthalmic surgery, application of long-lasting opiates should be avoided, and non-opiate analgesics and, depending on the kind of operation, antiemetic prophylactics are recommended.
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PMID:[What's new in ophthalmic anaesthesia?]. 1470 36

Significant anterior segment complications can occur following periocular or intraocular injections. These complications may be intraoperative or postoperative. They vary with different procedures and may be secondary to the surgical procedure or related to drug toxicity. Cataract and increased intraocular pressure are the most frequent complications. Other less commonly reported complications include hypotony, hyphema, corneal decompensation, strabismus, and cosmetic complications.
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PMID:Anterior segment complications following periocular and intraocular injections. 1553 52

Corticosteroid-induced glaucoma is a well-recognized phenomenon in adults, but not children. We describe an infant who developed juvenile glaucoma with buphthalmos while receiving systemic steroid treatment. The intraocular pressure normalized several months following discontinuation of treatment.
J Pediatr Ophthalmol Strabismus
PMID:Buphthalmos following systemic steroid treatment. 1702 66

A 6-year-old girl had total hyphema and elevated left intraocular pressure following trivial trauma. B-scan with vector A-scan revealed vitreous opacities consistent with hemorrhage. The drained hyphema did not recur. A left vascular conjunctival mass and massive cervical lymphadenopathy occurred 7 months later. Biopsy revealed extraocular retinoblastoma and lymph node metastasis. Computed tomography showed an intraocular mass with intracranial extension. She died of metastatic disease despite intensive chemotherapy. Retinoblastoma should be suspected in a child with hyphema following trivial trauma.
J Pediatr Ophthalmol Strabismus
PMID:Systemic metastasis following hyphema drainage in an unsuspected retinoblastoma. 1741 Sep 64

To compare the anti-inflammatory and analgesic effects of topical pranoprofen 0.1% with diclofenac sodium 0.1% after strabismus surgery, 40 patients were prospectively randomized and assigned into 2 groups. Signs and symptoms of inflammation, as well as intraocular pressure (IOP) of patients, were evaluated at 1 day and 1 and 3 weeks following surgery. Both groups reported reduced inflammation and discomfort at 1 week, as compared to 1 day. There was no statistically significant difference in any measurement of postoperative inflammation (i.e., discomfort, chemosis, secretion, conjunctival hyperemia, and conjunctival gap size) between the 2 groups at any time. None of the patients developed an allergic reaction to the medications and IOP measurements were within the normal limits in both groups. Pranoprofen 0.1% was found to be as effective as diclofenac sodium 0.1% in reducing inflammation and pain after strabismus surgery. Pranoprofen could be used as a safe and effective anti-inflammatory alternative for the treatment of inflammation following strabismus surgery.
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PMID:Topical pranoprofen 0.1% is as effective anti-inflammatory and analgesic agent as diclofenac sodium 0.1% after strabismus surgery. 1759 12

Conservative therapy in cases of severe thyroid ophthalmopathy has not given satisfactory results. Because of this, surgical treatment, that is, orbital decompression, is now being used with increasing frequency. Since the end of 1986 until the end of 2006, 103 patients with severe thyroid ophthalmopathy have been treated by personal 3-wall orbital decompression combined with removal of the periorbital, intraorbital, and retrobulbar fat, as well as with correction of eyelid retraction and deformities. After operation, all patients showed a significant reduction of exophthalmos (5-11 mm; 7.2 mm on average), reduction of intraocular pressure, marked improvement in ocular muscle function, and considerable reduction or disappearance of subjective symptoms. There was an improvement in vision in 68% patients who had impaired vision before the operation. There were no cases of subsequent impairment of ocular motility. Mild relapse of exophthalmos was recorded in 3 cases only, and only 1 patient required unilateral reoperation. Strabismus surgery had to be performed in 6 patients due to unsatisfactory correction of double vision. It can be concluded that this method of orbital decompression gives constantly very good functional and aesthetic long-term results and allows rapid recovery.
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PMID:Correction of exophthalmos and eyelid deformities in patients with severe thyroid ophthalmopathy. 1852 Mar 75

WE Gillies was a major contributor to research in glaucoma, notably pseuodexfoliation (XFS), as well as strabismus, particularly in relation to axial length (AL). The latter work involved breaking down the geometry of the eye to its basic components and using the measured AL to tailor the amount of strabismus surgery required. Similarly, the search for glaucoma genes requires us to break down glaucoma into its component measures and associated risk factors. Over the last 14 years, our data from the Glaucoma Inheritance Study in Tasmania have shown the following: that a family history is present in 60% of glaucoma cases; that 27% of members of large glaucoma families were unaware of their family history of glaucoma; and that familial glaucoma is more severe than sporadic glaucoma. Myocilin mutations account for 3% of cases of primary open angle glaucoma. Some genotype-phenotype correlations have been identified. Notably, with respect to earlier age of onset, higher maximum recorded intraocular pressure and need for surgery, the Gln368Stop mutation confers mild risk, Thr377Met and Gly252Arg mutations intermediate risk, and the Pro370Leu mutation severe risk. To identify the other genes associated with glaucoma, we have examined normal twins in the Twins Eye Study to determine the heritability of parameters that are abnormal in glaucoma - intraocular pressure and cup-to-disc ratio and confounding factors for glaucoma such as central corneal thickness, disc area, refraction and AL. We have identified high heritabilities for all of these as well as a gene locus associated with AL on chromosome 5. Recently, the LOXL1 gene was associated with XFS. Identification of further genes will improve our understanding of glaucoma and allow cascade genetic screening.
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PMID:Gillies lecture: dissecting glaucoma: understanding the molecular risk factors. 1892 13

Topical glaucoma medications are widely used for childhood glaucoma, although little is known concerning the use of the newer glaucoma medications in this population. The majority of the references cited were extracted from PubMed. A literature review of all English language reports related to glaucoma medication in the pediatric population since 1980 was performed. Medical therapy of pediatric glaucoma contains four groups of drugs: beta-blockers (timolol and betaxolol), carbonic anhydrase inhibitors (dorzolamide), alpha2-agonists (brimonidine), and prostaglandin analogs (latanoprost). Timolol is the first choice in pediatric glaucoma. In cases with insufficient reduction of the intraocular pressure (IOP), the combination of timolol once a day and dorzolamide twice a day brings about a good control of the IOP. Both medications are effective and well tolerated. The alpha2-agonists have more and potentially serious adverse effects in children and are contraindicated for children younger than 2 years of age. Latanoprost tends to be less effective in lowering IOP in children than in adults. However, no studies are reported where latanoprost is used in monotherapy. Additional study may further delineate this drug's role in treating pediatric glaucoma. The safety profile of latanoprost in children appears excellent.
J Pediatr Ophthalmol Strabismus
PMID:The safety and efficacy of glaucoma medication in the pediatric population. 1921 71

Congenital iris ectropion is an uncommon malformation and no reports exist about the use of modern technologies in this pathology. The authors describe a case of unilateral and isolated congenital iris ectropion associated with juvenile glaucoma in a healthy and completely asymptomatic 6-year-old girl with an unusual form of anisocoria. Optical coherence tomography and confocal scanning laser tomography showed a progressive glaucomatous neuropathy. A trabeculectomy without antimetabolites was performed and intraocular pressure normalized without other medications during a follow-up of 2 years. The authors assert the utility of various diagnostic technologies to recognize congenital iris ectropion early to prevent blindness in young patients and improve their prognosis.
J Pediatr Ophthalmol Strabismus
PMID:Congenital iris ectropion associated with juvenile glaucoma. 1921 75


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