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Abstracts of Ophthalmic Literature
ABSTRACTS OF OPHTHALMIC LITERATURE Compiled by JACQUELINE MORRIS, MARY BROWN, LEANE WERNER
ABBOT RL, METZ HS, WEBER AA: Saccadic velocity studies in Mobius syndrome. Ann Ophthalmol 10:619-623, 1978. The horizontal saccadic velocities in eight patients with Mobius syndrome were examined. A marked decrease in these saccades was found indicating significant weakness of the medial and lateral recti. APr L, AXELROD RN: Generalized fibrosis of the extraocular muscles. Am J Ophthalmol 85:822-829, 1978. The clinical, anatomic and histopathologic findings of four patients with generalized fibrosis syndrome are described. Histopathologic study revealed fibrous infiltration of the extrinsic eye muscles and Tenon's capsule without inflammatory changes. All patients achieved satisfactory functional and cosmetic results with strabismus and ptosis surgery. MDOUIN M, URVOY M: Visual acuity in preschool children: a new picture test. Pediatr Ophthalmol 15:392-393, 1978. A recently developed test for assessment of visual acuity in preschool children is described. The test utilizes pictures of animals (duck, rabbit, cock, elephant, fish, and butterfly) and may be performed at 2.5m or 5m. Good results can be obtained on children of at least three years of age. BERGIN DJ: Nasal heterotropia of the macula with persistent hyaloid vessel. J Pediatr Ophthalmol 15:373-375, 1978.
A case report is presented describing a patient with generalized tetanus that was complicated by a supranuclear palsy and exotropia. Recovery from the palsy occurred and the residual exotropia was subsequently surgically corrected. CALDEIRA JAF: Bilateral recession of the superior oblique in "A" pattern tropia. J Pediatr Ophthalmol 15:306-311, 1978. Bilateral recessions of overacting superior oblique muscles were performed in nine patients with "A" pattern strabismus. The recessions ranged from 11-15 mm with an average correction of 25 prism diopters. The author feels that this procedure is an effective, graduated method of treatment of "A" pattern strabismus in the presence of overacting superior oblique muscles.
CAMPBELL FW, HESS RF, WATSON PG, BANKS R: Preliminary results of a physiologically based treatment of amblyopia. Br J Ophthalmol 62:748-755, 1978. A recently developed device that employs high-contrast square wave gratings was used to treat patients with amblyopia. Twenty-two patients completed the treatment. The average number of sessions required to achieve maximum visual acuity was four, seven minute session. Results showed that in most cases visual acuity improved at distance and near and the regression of visual acuity after treatment was discontinued was never more than one Snellen line.
A case report is presented of a patient with an esotropia secondary to nasal dragging of the disc and nasal ectopia of the macula due to persistent hyaloid vessels.
CAMPOS EC: On the reliability of some tests of binocular sensorial status in strabismic patients. J Pediatr Ophthalmol 15:8-14, 1978.
BIGLAN AW, ELLIS FD, WADE TA: Supranuclear oculomotor palsy and extr~pia after tetanus. Am J Ophthalmol 86:666668, 1978.
In evaluating the sensory status of strabismic patients it is important to utilize tests that are as close as possible to casual seeing conditions. This insures that artifacts are not introduced that may produce problems
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in interpretation. The tests that are recommended are the striated glasses, the synoptophore and the after-image test.
CAPUTO AR, GREENFIELD PS: Cyclic esotropia. Ann Ophthalmol 10:775-778, 1978. A case report of a patient with cyclic esotropia is presented. Various factors that may initiate the cycle as well as various theories as to the nature of the clock mechanism are discussed. Spectacles or surgery are the common modes of therapy. When surgery is performed it is preferable to operate on a non-squinting day as this allows the patient maximum benefit of his more perfect fusional status. COLLIN JR, BEARD CWI: Experimental and clinical data on the insertion ofthe levator palpebrae superioris muscle. Am J Ophthalmol 85:792-801, 1978. Radiographic and electron microscopic evidence showed that the upper eyelid skin crease is formed by the insertion of the levator palpebrae superioris into the septa between the orbicularis muscle bundles and not into the skin itself. Experiments with monkeys showed that the insertions of the aponeurosis and of Muller's muscle both contribute to normal eyelid elevation. The authors found no histologic evidence for disinsertion of Muller's muscle causing blepharoptosis. COPPETO JM, LESSELL S: Cryptogenic unilateral paralysis of the superior oblique muscle. Arch Ophthalmol 96:275-277, 1978. The course of spontaneous isolated superior oblique palsies was examined in 15 patients. In none of the cases was a cause of the palsy ever determined. Nine patients had complete recovery within four months after the onset of the palsy. Of the six with residual diplopia only three needed prisms to function comfortably in the primary and reading positions. It is the authors' opinion that in cases of acquired isolated superior oblique palsies with otherwise normal general physical, ophthalmologic, and neurologic examinations, the prognosis for unassisted recovery is excellent. CzARNECKI JSC, THOMPSON HS: The iris sphincter in aberrant regeneration of the third nerve. Arch Ophthalmol 96:16061610, 1978.
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The pupils were examined in 14 patients with aberrant regeneration of the third nerve. The following phenomena were observed: sector contractions of the iris sphincter in response to light, sector contractions of the iris sphincter associated with "eye movements, abnormal pupillary unrest. These findings support the theory that following injury, fibers in the third nerve regenerate and grow in random ways, ending where they were not originally connected.
DANKER SR, MAsIL AJ, JAMPOLSKY A: Intentional surgical overcorrection of acquired esotropia. Arch OphthalmoI96:1848-1852, 1978. Postoperative fusional results in patients with acquired, non-accommodative esotropia and equal vision were reviewed to determine if surgical overcorrection was desirable. Two-thirds of the patients who were initially overcorrected by not mroe than ten prism diopters were fusing at least six months after surgery. Only one-third of the patients who were initially aligned or undercorrected were fusing six months or more postoperatively. This seems to indicate that an initial overcorrection of not more than ten prism diopters is a desirable result in patients with acquired, non-accommodative esotropia.
GALIN MA, BARAS I: Stereoscopic acuity measurement in aphakia. Am J Ophthalmol 86:825-827, 1978. A number of tests were performed on binocular and monocular aphakes in order to measure stereoacuity and, thus, to assess their binocular function. Patients wearing intraocular lenses and patients wearing contact. lenses had equally good stereoacuity. Both groups also had better results than patients wearing spectacles.
GOLDBERG RT: Vertical pendular nystagmus in chronic myositis of medial and lateral rectus. Ann Ophthalmol 10:16971702, 1978. A patient with recurrent left medial rectus myositis and left lateral rectus myositis developed vertical pendular nystagmus in left gaze. General physical and neurologic examinations were normal. It is felt that this is the first case report of vertical nystagmus associated with chronic myositis.
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GOLDSTEIN JH: Modification of the Jensen procedure. J Pediatr Ophthalmol 15:321322, 1978. The author proposes a modification of the Jensen procedure for repair of a sixth nerve palsy. The superior and inferior recti are each divided into two segments, the lateral segments being one-third the width of the muscles. These segments are each connected to a segment of the lateral rectus that is one-third the width of that muscle. It is felt that in this way more of the muscles, and therefore more of the blood supply, are left undisturbed in order to reduce the possibility of anterior segment ischemia. GRESTY M, HALMAGYI GM, LEECH J: The relationship between head and eye movement in congenital nystagmus with head shaking: objective recordings of a single case. Br J Ophthalmol 62:533-535, 1978. Head shaking and congenital nystagmus were recorded in a patient while she performed visual tasks. When attentive, her nystagmus slowed from six cycles per second to 2 - 2.6 cycles per second and the head shaking, which was phase-locked to the nystagmus, occurred occasionally. The authors suggest that the head shaking and the nystagmus may have a common pathologic origin and that the pattern of head and eye nodding are altered to permit periods of foveal fixation.
GRIMSON BS, GLASER JS: Isolated trochlear nerve palsies in herpes zoster ophthalmicus. Arch Ophthalmol 96:1233-1235, 1978. In six patients the only ocular motor manifestation of herpes zoster ophthalmicus was isolated fourth nerve palsies. Possibilities of mechanisms that could cause this include local inflammation, intracavernous spread of inflammation from the trigeminal nerve and an independent motor neuropathy or ganglionitis. Delaying surgical intervention in these cases is advocated because of the variability of the clinical course. HAMTIL LW, PLACE KC: Review of surgical results using bilateral lateral rectus recession for the correction of exodeviations. Ann Ophthalmol 10:1731-1734, 1978. Bilateral lateral rectus recessions were performed as an initial procedure for exodeviations. Results showed that for deviations of 406 or less, successful results were
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obtained in 93% of the patients. For deviations of 456 or more the success rate was 50%. The authors also found that the type of exodeviation did not correlate significantly with satisfactory surgical results. There was also no significant correlation between the age of the patient and successful surgical results.
HARDESTY HH, BOYNTON JR, KEENAN P: Treatment of intermittent exotropia. Arch Ophthalmol 96:268-274, 1978. One hundred consecutive patients with intermittent exotropia were followed for an average of 6.1 years after undergoing bilateral lateral rectus recessions. Approximately half of the patients achieved satisfactory results with surgery alone. With help from orthoptics, prisms and second surgical procedures the overall cure rate was 78%. It was found that only patients with a divergence excess type of intermittent exotropia had the distance deviation corrected more than the near deviation with bilateral lateral rectus recessions. It was also found that this procedure was not significantly more effective in divergence excess deviations than in basic types of intermittent exotropia. HARLEY RD, RoDRIGUES MM, CRAWFORD JS: Congenital fibrosis of the extraocular muscles. J Pediatr OphthalmolI5:346-358, 1978. Congenital fibrosis of the extraocular muscles presents various clinical pictures depending upon which muscles are affected. In all cases normal contractile muscle tissue is replaced by fibrous tissue or fibrous bands in varying degrees. Surgical management is aimed at eliminating abnormal head postures and adjusting the ocular and lid position to achieve an acceptable cosmetic appearance. HARPER DG: Topical anesthesia for inferior rectus recession in thyroid ophthalmopathy. Ann Ophthalmol 10:499, 1978. A technique is described for recession of the inferior rectus in patients with thyroid myopathy. Mter disinserting the muscle the patient is asked to look in maximum upgaze. The inferior rectus is then reinserted at the point where it contacts the globe. This allows maximum upward rotation of the previously hypotropic eye.
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HERMANN JS: Acquired Brown's syndrome of inflammatory origin. Arch Ophthalmol 96:1228-1232, 1978. In two cases of acquired Brown's syndrome with localized inflammatory signs in the trochlear region, marked improvement was noted following a series of direct injections of methylprednisone acetate into the trochlear region. This form of treatment is thought to be of significant value in cases of acquired Brown's syndrome when signs of localized inflammation are present.
HIATr RL: Production of anterior segment ischemia. J Pediatr Ophthalmol 15:197204, 1978. The most common cause of anterior segment ischemia is the removal of more than two rectus muscles. After disinsertion of at least three rectus muscles, 20 dog eyes and eight monkey eyes were studied microscopically and grossly. The author could find no relationship between the particular muscle combinations which were severed and the reaction produced. It was also found that the gross reaction (lid edema, conjunctival chemosis, edema and haze of the cornea, cells and flare in the anterior chamber) was more marked than the microscopic reaction.
HIATr RL, COPE-TROUPE C: Abnormal head positions due to ocular problems. Ann Ophthalmol 10:881-892, 1978. Thirty patients with abnormal headpositions were examined. Fusion could be demonstrated in 73% of these patients. It is believed that the abnormal head posture was adopted to maintain fusion. Eight case reports are presented to illustrate this point.
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IKEDA H, TREMAIN KE: Amblyopia resulting from penalisation: neurophysiological studies of kittens reared with atropinisation of one or both eyes. Br J Ophthalmol 62:21-28, 1978. Atropinsation of the eyes of young kittens was found to cause a reduction in the spatial resolving power of cells in the lateral genicu· late nucleus driven by the penalised eye(s). Binocularity of cells in the visual cortex was reduced only in cases of monocular penalisation. The authors felt this showed that the development of good visual acuity depends on sharply focused foveal images. Develop· ment of binocular vision, on the other hand, depends on equality of the input to the two eyes. JACOBS HB: Pseudostrabismus: an audit. Br J Ophthalmol 62:763-764, 1978. A total of 331 children presenting initially with pseudostrabism us were assessed. Of the patients with ametropia, 24% subsequently developed esotropia. Only 1.65% of the emmetropes developed a true squint. It was felt that close follow-up of emmetropic patients with pseudostrabismus is not necessary. KANI W: Stereopsis and spatial perception in am blyopes and uncorrected ametropes. Br J Ophthalmol 62:756·762, 1978. The performance of amblyopes and nonamblyopes on two tests of spatial perception was compared. The Titmus stereotest mea· sured pure stereopsis. The three-rods test measured the precision of distance discrimination. On both tests the amblyopes performed significantly worse than the non· amblyopes.
HoYT CS: Acquired "double elevator palsy" and polycythemia vera. J Pediatr Oph· thalmol 15:362-365, 1978.
KAZARIAN EL, FLYNN IT: Congenital third nerve palsy with amblyopia of the contralateral eye. J Pediatr Ophthalmol 15:366367, 1978.
A case report is presented of a patient with polycythemia vera who had a sudden onset of a double elevator palsy. The author suggests that an occlusive episode occurred in the region of the superior rectus subnucleus resulting in the ocular movement disorder.
Patients with isolated congenital oculomotor nerve palsies commonly present with amblyopia in the affected eye. This is believed to be the first case report of the palsied eye being used for fixation and amblyopia developing in the secondarily deviated eye.
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LEVY NS, LAN DAY S: Infantile glaucoma associated with contralateral esotropia. J Pediatr Ophthalmol 15:368-369, 1978.
OLDER JJ: Levator aponeurosis disinsertion in the young adult. Arch Ophthalmol 96: 1857-1858, 1978.
A case report is presented in which an infant with an early-onset esotropia subsequently developed glaucoma of the fixing eye. A neurologic examination proved to be unremarkable. Treatment consisted of trabeculotomy and patching the preferred eye. Ultimately the amblyopia was reversed and the angle of strabismus reduced.
Three patients under 35 years of age gave a history of upper lid edema for a considerable length of time followed by an acquired ptosis. Examination under local anesthesia revealed a levator aponeurosis disinsertion in all cases. Ptosis repair was successfully carried out. It is felt that lid edema for an extended length of time is sufficient to cause levator disinsertion in the young.
MANAINI G, PORTA R: Interocular transfer of a visual aftereffect in early onset esotropia. Arch Ophthalmol 96:1853-1856, 1978.
PALMER EA, VON NOORDEN GK: The relationship between fixation disparity and heterophoria. Am J Ophthalmol 85:172176, 1978.
The interocular transfer of a visual aftereffect was studied in patients with earlyonset esotropia. Data showed that there was microtropia and large angle esotropia. Patients with monocular microtropia and a moderate to low degree of amblyopia had reduced visual aftereffect in the dominant eye with almost no transfer while the reverse was true for their non-dominant eye. The authors feel that this test is a poor indicator of binocularity in strabismic patients.
METZ HS, SMITH G: Abduction nystagmus. J Pediatr Ophthalmol 15:312-317, 1978. Electro-ocu1ography studies were performed on a patient with abduction nystagmus. It was discovered that the fast phase of the nystagmus was toward abduction of the fixing eye. However, in marked abduction the direction of the fast phase was reversed. Convergence was not necessary to decrease the amplitude of the nystagmus. Neither was there any evidence of lateral rectus palsy that might cause nystagmus that was more marked in abduction.
NEMET P, RON S: Ocular saccades in Duane's syndrome. Br J Ophthalmol 62:528-532, 1978. Ten patients with Duane's syndrome were studied and their eye movements were measured. The study showed that the motility of the sound eye was also affected by Duane's syndrome. When adduction of the affected eye is present, Hering's law can be demonstrated but when adduction is limited this law does not hold.
The relationship between fixation disparity and heterophoria was investigated in a population with normal binocular vision. A phase difference haploscope was used to simulate casual conditions of sight. Twentyfive subjects had the magnitude and direction of their heterophorias and fixation disparities determined. Analysis of the data suggested that normal, small magnitude heterophorias do not necessarily produce fixation disparities, and that fixation disparities do not necessarily sustain heterophorias.
PAQUE JT, MUMMA JV: Vertical offsets of the horizontal recti. J Pediatr Ophthalmol 15:205-209, 1978. Vertically displacing the horizontal recti can help correct hyperdeviations that are often associated with horizontal strabismus. Results of such procedures on 30 patients revealed that 1-2 mm of vertical displacement yielded an average vertical correction of three prism diopters. An average of eight prism diopters may be obtained with 2.5-3.0 mm of vertical displacement. An average vertical correction of 12 prism diopters was obtained with 4.0-4.5 mm of vertical offset. PEARCE WG: Congenital nystagmus-genetic and environmental causes. Can J Ophthalmol 13:1-9, 1978. Forty patients with congenital nystagmus were surveyed in order to determine if a specific entity could be identified as a causative factor. In 33 cases an abnormal single gene was responsible for the nystagmus. Optic atrophy associated with peri-
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natal damage was responsible in one patient. No specific factor could be identified in the remaining six cases. POLLARD Z: Superior oblique tenectomy in A pattern strabismus. Ann Ophthalmol 10: 211-215, 1978. Surgical results were evaluated in patients with A pattern strabismus and overacting superior oblique muscles. Satisfactory results were obtained in down gaze with bilateral superior oblique tenectomies. However, the author found that this procedure yielded an average correction in primary position of only 3.3 prism diopters. For this reason the author advocates combined superior oblique tenectomies and horizontal muscle surgery when there is a deviation in primary position of at least 25 prism diopters. PU'ITERMAN AM: Ectropion of the lower eyelid secondary to MUller's muscle-capsulopalpebral fascia detachment. Am J Ophthalmol 85:814-817, 1978. A case report of another cause of ectropion was presented. The ectropion was due to detachment of Muller's muscle and capsulopalpebral fascia from the inferior tarsus and recession of these tissues into the orbit. To relieve the ectropion, MUller's muscle and capsulopalpebral fascia were reattached to the inferior tarsus. ROGERS GL, SIMMONS RE: Inferior rectus muscle fibrosis following orbital trauma. J Pediatr Ophthalmol 15:318-320, 1978. Diplopia and restriction of voluntary and involuntary elevation was noted to develop in three patients several weeks following blunt trauma to the orbit. None of the patients had orbital floor fractures. All did show fibrosis and adhesions to the inferior rectus and inferior oblique muscles. Treatment was surgical in all cases aiming to eliminate diplopia in the primary and reading positions. ROMEM M, GASUL Z: Simultaneous fourmuscle surgery in V-esotropia. J Pediatr Ophthalmol 15:5-7, 1978. The results of bilateral medial rectus recessions as a single procedure or in combination with bilateral inferior oblique recessions or myectomies were reviewed. Cases in which there was marked overaction of both
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inferior obliques obtained better results with simultaneous four-muscle surgery. However, in V-esotropia in which there was moderate overaction of the inferior obliques, satisfactory results were obtained with horizontal surgery alone. ROSENBAUM AL, WEISS SJ: Monozygotic twins discordant for Duane's retraction syndrome. J Pediatr Ophthalmol 15:359361, 1978. In a set of monozygotic twins only one was affected with Duane's retraction syndrome. Some of the theoretical problems which this situation produces are discussed. Complications at birth appears to be the least objectionable explanation for this occurrence. SCHECHTER RJ: Ptosis with contralateral lid retraction due to excessive innervation of the levator palpebrae superiorus. Ann Ophthalmol 10:1324-1328, 1978. Two case reports of patients with unilateral ptosis and contralateral lid retraction are presented. The author feels that, due to Hering's law, the excessive innervation supplied to the preferred, ptotic eye is transmitted to the opposite, non-preferred eye resulting in lid retraction. The author notes that if the ptotic lid is manually elevated the contralateral lid retraction decreases in seconds. He feels that this method for the evaluation of unequal ptosis is superior to the previously reported method of patching the ptotic eye. SETAYESH AR, KHODADOUsr AA, DARYANI SM: Microtropia. Arch Ophthalmol 96: 1842-1847, 1978. Fifty patients with microtropia, all of whom had some degree of anisometropia, were studied. Only two patients were found to have developed a microtropia after treatment for an -originally large angle of strabismus. The remaining 48 patients had primary microtropia. In almost all cases the amblyopic eye was the one with the greater refractive error. For this reason the authors feel that uncorrected anisometropia is the main factor causing foveal suppression in patients with primary microtropia. SHIPPMAN S, HERMANN JS: Antipodean squint. J Pediatr Ophthalmol 15:210-212, 1978.
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Three case reports are presented of patients who demonstrated an esotropia when fixating with one eye and an exotropia when fixating with the other eye. None of the patients had anisometropia, previous ocular muscle surgery, unequal accommodation, paralysis or restriction of an extraocular muscle, pseudoexotropia secondary to an ectopic macula or any pathology that could result in such a deviation. SINGH G, DAS PN: Pattern of amblyopia and fixation after keratoplasty. Br J Ophthalmol 62:29-33, 1978. The pattern of amblyopia and fixation was investigated in 40 cases of clear corneal grafts. The authors concluded that when an opacity is unilateral and arises before the age of five years and when corneal grafting is delayed until adulthood, a severe amblyopia develops. When the corneal opacities are bilateral, the amblyopia is not very dense and in at least one eye good visual improvement occurs after corneal grafting. When a corenal opacity develops after the age of seven it has no significant influence on the amblyopia or the fixation pattern, regardless of the interval between its development and surgery. SPECTOR RH, SMITH JL, CHAVIS PS: Charcot-Marie-tooth disease mimicking ocular myasthenia gravis. Ann Ophthalmol 10: 1033-1036, 1978. Intermittent ocular signs, often the presenting signs in myasthenia gravis, may represent the onset of chronic progressive external ophthalmoplegia (CPEO). A case report is presented in which CPEO is a complicating factor of Charcot-Marie-tooth disease. ThOBE JD, GLASER JS, QUENCER RC: Isolated oculomotor paralysis. Arch Ophthalmol 96:1236-1240, 1978. An isolated third nerve palsy is a common symptom in patients with aneurysms. In the majority of cases these aneurysms are located in the anterior circulation, usually at the junction of the internal carotid and posterior communicating arteries. Rarely have oculomotor palsies been described in connection with aneurysms of the posterior circulation. In this article two such cases are
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presented in which patients with aneurysms of the posterior circulation developed third nerve palsies. VON NOORDEN GK, MORRIS J, EDELMAN P: Efficacy of bifocals in the treatment of accommodative esotropia. Am J Ophthalmol 85:83a.834, 1978. Eighty-four patients with partially refractive, accommodative esotropia were treated with bifocals to assist in controlling their near deviations. Patients with high AC/ A ratios had the highest cure rate with respect to eventual control of the deviation without assistance from bifocals or surgery. Patients with low AC/ A ratios tended to be either totally dependent on the bifocals to help control their near deviation, or their control of the deviation deteriorated while under maximal bifocal therapy. WILLIAMS AT, METZ HS, JAMPOLSKY A: The O'Connor cinch revisited. Br J Ophthalmol 62:765-769, 1978. After performing an O'Connor cinch in 17 patients, the results were reviewed. An average of 4 mm of resection was obtained with the standard procedure which is described in the article. Adj usting some or all of the strands on the first postoperative day yielded a 106 to 206 reduction in the deviation. There was also an additional "stretching out" of the cinch effect for two to four weeks after adjustment. The authors felt that the O'Connor cinch is a useful, adjustable resection procedure that can be used in children as well as adults. WOOD ICJ, Fox JA, STEPHENSON MG: Contrast threshold of random dot stereograms in anisometropic amblyopia: a clinical investigation. Br J Ophthalmol 62:34-38, 1978. The contrast thresholds of random dot stereograms were studied in normal patients and in patients with anisometropic amblyopia. There was a marked elevation of the contrast threshold of both the sound eye and the amblyopic eye under binocular testing conditions when compared with the normal subjects. The elevation was also greater when alignment of the two fovea was poor. These findings suggested that the mechanism of amblyopia is due to a reduction in the number of functioning binocular cells.
ABBOT RL, METZ HS, WEBER AA: Saccadic velocity studies in Mobius syndrome. Ann Ophthalmol 10:619-623, 1978. The horizontal saccadic velocities in eight patients with Mobius syndrome were examined. A marked decrease in these saccades was found indicating significant weakness of the medial and lateral recti. APr L, AXELROD RN: Generalized fibrosis of the extraocular muscles. Am J Ophthalmol 85:822-829, 1978. The clinical, anatomic and histopathologic findings of four patients with generalized fibrosis syndrome are described. Histopathologic study revealed fibrous infiltration of the extrinsic eye muscles and Tenon's capsule without inflammatory changes. All patients achieved satisfactory functional and cosmetic results with strabismus and ptosis surgery. MDOUIN M, URVOY M: Visual acuity in preschool children: a new picture test. Pediatr Ophthalmol 15:392-393, 1978. A recently developed test for assessment of visual acuity in preschool children is described. The test utilizes pictures of animals (duck, rabbit, cock, elephant, fish, and butterfly) and may be performed at 2.5m or 5m. Good results can be obtained on children of at least three years of age. BERGIN DJ: Nasal heterotropia of the macula with persistent hyaloid vessel. J Pediatr Ophthalmol 15:373-375, 1978.
A case report is presented describing a patient with generalized tetanus that was complicated by a supranuclear palsy and exotropia. Recovery from the palsy occurred and the residual exotropia was subsequently surgically corrected. CALDEIRA JAF: Bilateral recession of the superior oblique in "A" pattern tropia. J Pediatr Ophthalmol 15:306-311, 1978. Bilateral recessions of overacting superior oblique muscles were performed in nine patients with "A" pattern strabismus. The recessions ranged from 11-15 mm with an average correction of 25 prism diopters. The author feels that this procedure is an effective, graduated method of treatment of "A" pattern strabismus in the presence of overacting superior oblique muscles.
CAMPBELL FW, HESS RF, WATSON PG, BANKS R: Preliminary results of a physiologically based treatment of amblyopia. Br J Ophthalmol 62:748-755, 1978. A recently developed device that employs high-contrast square wave gratings was used to treat patients with amblyopia. Twenty-two patients completed the treatment. The average number of sessions required to achieve maximum visual acuity was four, seven minute session. Results showed that in most cases visual acuity improved at distance and near and the regression of visual acuity after treatment was discontinued was never more than one Snellen line.
A case report is presented of a patient with an esotropia secondary to nasal dragging of the disc and nasal ectopia of the macula due to persistent hyaloid vessels.
CAMPOS EC: On the reliability of some tests of binocular sensorial status in strabismic patients. J Pediatr Ophthalmol 15:8-14, 1978.
BIGLAN AW, ELLIS FD, WADE TA: Supranuclear oculomotor palsy and extr~pia after tetanus. Am J Ophthalmol 86:666668, 1978.
In evaluating the sensory status of strabismic patients it is important to utilize tests that are as close as possible to casual seeing conditions. This insures that artifacts are not introduced that may produce problems
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ABSTRACTS
in interpretation. The tests that are recommended are the striated glasses, the synoptophore and the after-image test.
CAPUTO AR, GREENFIELD PS: Cyclic esotropia. Ann Ophthalmol 10:775-778, 1978. A case report of a patient with cyclic esotropia is presented. Various factors that may initiate the cycle as well as various theories as to the nature of the clock mechanism are discussed. Spectacles or surgery are the common modes of therapy. When surgery is performed it is preferable to operate on a non-squinting day as this allows the patient maximum benefit of his more perfect fusional status. COLLIN JR, BEARD CWI: Experimental and clinical data on the insertion ofthe levator palpebrae superioris muscle. Am J Ophthalmol 85:792-801, 1978. Radiographic and electron microscopic evidence showed that the upper eyelid skin crease is formed by the insertion of the levator palpebrae superioris into the septa between the orbicularis muscle bundles and not into the skin itself. Experiments with monkeys showed that the insertions of the aponeurosis and of Muller's muscle both contribute to normal eyelid elevation. The authors found no histologic evidence for disinsertion of Muller's muscle causing blepharoptosis. COPPETO JM, LESSELL S: Cryptogenic unilateral paralysis of the superior oblique muscle. Arch Ophthalmol 96:275-277, 1978. The course of spontaneous isolated superior oblique palsies was examined in 15 patients. In none of the cases was a cause of the palsy ever determined. Nine patients had complete recovery within four months after the onset of the palsy. Of the six with residual diplopia only three needed prisms to function comfortably in the primary and reading positions. It is the authors' opinion that in cases of acquired isolated superior oblique palsies with otherwise normal general physical, ophthalmologic, and neurologic examinations, the prognosis for unassisted recovery is excellent. CzARNECKI JSC, THOMPSON HS: The iris sphincter in aberrant regeneration of the third nerve. Arch Ophthalmol 96:16061610, 1978.
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The pupils were examined in 14 patients with aberrant regeneration of the third nerve. The following phenomena were observed: sector contractions of the iris sphincter in response to light, sector contractions of the iris sphincter associated with "eye movements, abnormal pupillary unrest. These findings support the theory that following injury, fibers in the third nerve regenerate and grow in random ways, ending where they were not originally connected.
DANKER SR, MAsIL AJ, JAMPOLSKY A: Intentional surgical overcorrection of acquired esotropia. Arch OphthalmoI96:1848-1852, 1978. Postoperative fusional results in patients with acquired, non-accommodative esotropia and equal vision were reviewed to determine if surgical overcorrection was desirable. Two-thirds of the patients who were initially overcorrected by not mroe than ten prism diopters were fusing at least six months after surgery. Only one-third of the patients who were initially aligned or undercorrected were fusing six months or more postoperatively. This seems to indicate that an initial overcorrection of not more than ten prism diopters is a desirable result in patients with acquired, non-accommodative esotropia.
GALIN MA, BARAS I: Stereoscopic acuity measurement in aphakia. Am J Ophthalmol 86:825-827, 1978. A number of tests were performed on binocular and monocular aphakes in order to measure stereoacuity and, thus, to assess their binocular function. Patients wearing intraocular lenses and patients wearing contact. lenses had equally good stereoacuity. Both groups also had better results than patients wearing spectacles.
GOLDBERG RT: Vertical pendular nystagmus in chronic myositis of medial and lateral rectus. Ann Ophthalmol 10:16971702, 1978. A patient with recurrent left medial rectus myositis and left lateral rectus myositis developed vertical pendular nystagmus in left gaze. General physical and neurologic examinations were normal. It is felt that this is the first case report of vertical nystagmus associated with chronic myositis.
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GOLDSTEIN JH: Modification of the Jensen procedure. J Pediatr Ophthalmol 15:321322, 1978. The author proposes a modification of the Jensen procedure for repair of a sixth nerve palsy. The superior and inferior recti are each divided into two segments, the lateral segments being one-third the width of the muscles. These segments are each connected to a segment of the lateral rectus that is one-third the width of that muscle. It is felt that in this way more of the muscles, and therefore more of the blood supply, are left undisturbed in order to reduce the possibility of anterior segment ischemia. GRESTY M, HALMAGYI GM, LEECH J: The relationship between head and eye movement in congenital nystagmus with head shaking: objective recordings of a single case. Br J Ophthalmol 62:533-535, 1978. Head shaking and congenital nystagmus were recorded in a patient while she performed visual tasks. When attentive, her nystagmus slowed from six cycles per second to 2 - 2.6 cycles per second and the head shaking, which was phase-locked to the nystagmus, occurred occasionally. The authors suggest that the head shaking and the nystagmus may have a common pathologic origin and that the pattern of head and eye nodding are altered to permit periods of foveal fixation.
GRIMSON BS, GLASER JS: Isolated trochlear nerve palsies in herpes zoster ophthalmicus. Arch Ophthalmol 96:1233-1235, 1978. In six patients the only ocular motor manifestation of herpes zoster ophthalmicus was isolated fourth nerve palsies. Possibilities of mechanisms that could cause this include local inflammation, intracavernous spread of inflammation from the trigeminal nerve and an independent motor neuropathy or ganglionitis. Delaying surgical intervention in these cases is advocated because of the variability of the clinical course. HAMTIL LW, PLACE KC: Review of surgical results using bilateral lateral rectus recession for the correction of exodeviations. Ann Ophthalmol 10:1731-1734, 1978. Bilateral lateral rectus recessions were performed as an initial procedure for exodeviations. Results showed that for deviations of 406 or less, successful results were
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obtained in 93% of the patients. For deviations of 456 or more the success rate was 50%. The authors also found that the type of exodeviation did not correlate significantly with satisfactory surgical results. There was also no significant correlation between the age of the patient and successful surgical results.
HARDESTY HH, BOYNTON JR, KEENAN P: Treatment of intermittent exotropia. Arch Ophthalmol 96:268-274, 1978. One hundred consecutive patients with intermittent exotropia were followed for an average of 6.1 years after undergoing bilateral lateral rectus recessions. Approximately half of the patients achieved satisfactory results with surgery alone. With help from orthoptics, prisms and second surgical procedures the overall cure rate was 78%. It was found that only patients with a divergence excess type of intermittent exotropia had the distance deviation corrected more than the near deviation with bilateral lateral rectus recessions. It was also found that this procedure was not significantly more effective in divergence excess deviations than in basic types of intermittent exotropia. HARLEY RD, RoDRIGUES MM, CRAWFORD JS: Congenital fibrosis of the extraocular muscles. J Pediatr OphthalmolI5:346-358, 1978. Congenital fibrosis of the extraocular muscles presents various clinical pictures depending upon which muscles are affected. In all cases normal contractile muscle tissue is replaced by fibrous tissue or fibrous bands in varying degrees. Surgical management is aimed at eliminating abnormal head postures and adjusting the ocular and lid position to achieve an acceptable cosmetic appearance. HARPER DG: Topical anesthesia for inferior rectus recession in thyroid ophthalmopathy. Ann Ophthalmol 10:499, 1978. A technique is described for recession of the inferior rectus in patients with thyroid myopathy. Mter disinserting the muscle the patient is asked to look in maximum upgaze. The inferior rectus is then reinserted at the point where it contacts the globe. This allows maximum upward rotation of the previously hypotropic eye.
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HERMANN JS: Acquired Brown's syndrome of inflammatory origin. Arch Ophthalmol 96:1228-1232, 1978. In two cases of acquired Brown's syndrome with localized inflammatory signs in the trochlear region, marked improvement was noted following a series of direct injections of methylprednisone acetate into the trochlear region. This form of treatment is thought to be of significant value in cases of acquired Brown's syndrome when signs of localized inflammation are present.
HIATr RL: Production of anterior segment ischemia. J Pediatr Ophthalmol 15:197204, 1978. The most common cause of anterior segment ischemia is the removal of more than two rectus muscles. After disinsertion of at least three rectus muscles, 20 dog eyes and eight monkey eyes were studied microscopically and grossly. The author could find no relationship between the particular muscle combinations which were severed and the reaction produced. It was also found that the gross reaction (lid edema, conjunctival chemosis, edema and haze of the cornea, cells and flare in the anterior chamber) was more marked than the microscopic reaction.
HIATr RL, COPE-TROUPE C: Abnormal head positions due to ocular problems. Ann Ophthalmol 10:881-892, 1978. Thirty patients with abnormal headpositions were examined. Fusion could be demonstrated in 73% of these patients. It is believed that the abnormal head posture was adopted to maintain fusion. Eight case reports are presented to illustrate this point.
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IKEDA H, TREMAIN KE: Amblyopia resulting from penalisation: neurophysiological studies of kittens reared with atropinisation of one or both eyes. Br J Ophthalmol 62:21-28, 1978. Atropinsation of the eyes of young kittens was found to cause a reduction in the spatial resolving power of cells in the lateral genicu· late nucleus driven by the penalised eye(s). Binocularity of cells in the visual cortex was reduced only in cases of monocular penalisation. The authors felt this showed that the development of good visual acuity depends on sharply focused foveal images. Develop· ment of binocular vision, on the other hand, depends on equality of the input to the two eyes. JACOBS HB: Pseudostrabismus: an audit. Br J Ophthalmol 62:763-764, 1978. A total of 331 children presenting initially with pseudostrabism us were assessed. Of the patients with ametropia, 24% subsequently developed esotropia. Only 1.65% of the emmetropes developed a true squint. It was felt that close follow-up of emmetropic patients with pseudostrabismus is not necessary. KANI W: Stereopsis and spatial perception in am blyopes and uncorrected ametropes. Br J Ophthalmol 62:756·762, 1978. The performance of amblyopes and nonamblyopes on two tests of spatial perception was compared. The Titmus stereotest mea· sured pure stereopsis. The three-rods test measured the precision of distance discrimination. On both tests the amblyopes performed significantly worse than the non· amblyopes.
HoYT CS: Acquired "double elevator palsy" and polycythemia vera. J Pediatr Oph· thalmol 15:362-365, 1978.
KAZARIAN EL, FLYNN IT: Congenital third nerve palsy with amblyopia of the contralateral eye. J Pediatr Ophthalmol 15:366367, 1978.
A case report is presented of a patient with polycythemia vera who had a sudden onset of a double elevator palsy. The author suggests that an occlusive episode occurred in the region of the superior rectus subnucleus resulting in the ocular movement disorder.
Patients with isolated congenital oculomotor nerve palsies commonly present with amblyopia in the affected eye. This is believed to be the first case report of the palsied eye being used for fixation and amblyopia developing in the secondarily deviated eye.
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LEVY NS, LAN DAY S: Infantile glaucoma associated with contralateral esotropia. J Pediatr Ophthalmol 15:368-369, 1978.
OLDER JJ: Levator aponeurosis disinsertion in the young adult. Arch Ophthalmol 96: 1857-1858, 1978.
A case report is presented in which an infant with an early-onset esotropia subsequently developed glaucoma of the fixing eye. A neurologic examination proved to be unremarkable. Treatment consisted of trabeculotomy and patching the preferred eye. Ultimately the amblyopia was reversed and the angle of strabismus reduced.
Three patients under 35 years of age gave a history of upper lid edema for a considerable length of time followed by an acquired ptosis. Examination under local anesthesia revealed a levator aponeurosis disinsertion in all cases. Ptosis repair was successfully carried out. It is felt that lid edema for an extended length of time is sufficient to cause levator disinsertion in the young.
MANAINI G, PORTA R: Interocular transfer of a visual aftereffect in early onset esotropia. Arch Ophthalmol 96:1853-1856, 1978.
PALMER EA, VON NOORDEN GK: The relationship between fixation disparity and heterophoria. Am J Ophthalmol 85:172176, 1978.
The interocular transfer of a visual aftereffect was studied in patients with earlyonset esotropia. Data showed that there was microtropia and large angle esotropia. Patients with monocular microtropia and a moderate to low degree of amblyopia had reduced visual aftereffect in the dominant eye with almost no transfer while the reverse was true for their non-dominant eye. The authors feel that this test is a poor indicator of binocularity in strabismic patients.
METZ HS, SMITH G: Abduction nystagmus. J Pediatr Ophthalmol 15:312-317, 1978. Electro-ocu1ography studies were performed on a patient with abduction nystagmus. It was discovered that the fast phase of the nystagmus was toward abduction of the fixing eye. However, in marked abduction the direction of the fast phase was reversed. Convergence was not necessary to decrease the amplitude of the nystagmus. Neither was there any evidence of lateral rectus palsy that might cause nystagmus that was more marked in abduction.
NEMET P, RON S: Ocular saccades in Duane's syndrome. Br J Ophthalmol 62:528-532, 1978. Ten patients with Duane's syndrome were studied and their eye movements were measured. The study showed that the motility of the sound eye was also affected by Duane's syndrome. When adduction of the affected eye is present, Hering's law can be demonstrated but when adduction is limited this law does not hold.
The relationship between fixation disparity and heterophoria was investigated in a population with normal binocular vision. A phase difference haploscope was used to simulate casual conditions of sight. Twentyfive subjects had the magnitude and direction of their heterophorias and fixation disparities determined. Analysis of the data suggested that normal, small magnitude heterophorias do not necessarily produce fixation disparities, and that fixation disparities do not necessarily sustain heterophorias.
PAQUE JT, MUMMA JV: Vertical offsets of the horizontal recti. J Pediatr Ophthalmol 15:205-209, 1978. Vertically displacing the horizontal recti can help correct hyperdeviations that are often associated with horizontal strabismus. Results of such procedures on 30 patients revealed that 1-2 mm of vertical displacement yielded an average vertical correction of three prism diopters. An average of eight prism diopters may be obtained with 2.5-3.0 mm of vertical displacement. An average vertical correction of 12 prism diopters was obtained with 4.0-4.5 mm of vertical offset. PEARCE WG: Congenital nystagmus-genetic and environmental causes. Can J Ophthalmol 13:1-9, 1978. Forty patients with congenital nystagmus were surveyed in order to determine if a specific entity could be identified as a causative factor. In 33 cases an abnormal single gene was responsible for the nystagmus. Optic atrophy associated with peri-
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natal damage was responsible in one patient. No specific factor could be identified in the remaining six cases. POLLARD Z: Superior oblique tenectomy in A pattern strabismus. Ann Ophthalmol 10: 211-215, 1978. Surgical results were evaluated in patients with A pattern strabismus and overacting superior oblique muscles. Satisfactory results were obtained in down gaze with bilateral superior oblique tenectomies. However, the author found that this procedure yielded an average correction in primary position of only 3.3 prism diopters. For this reason the author advocates combined superior oblique tenectomies and horizontal muscle surgery when there is a deviation in primary position of at least 25 prism diopters. PU'ITERMAN AM: Ectropion of the lower eyelid secondary to MUller's muscle-capsulopalpebral fascia detachment. Am J Ophthalmol 85:814-817, 1978. A case report of another cause of ectropion was presented. The ectropion was due to detachment of Muller's muscle and capsulopalpebral fascia from the inferior tarsus and recession of these tissues into the orbit. To relieve the ectropion, MUller's muscle and capsulopalpebral fascia were reattached to the inferior tarsus. ROGERS GL, SIMMONS RE: Inferior rectus muscle fibrosis following orbital trauma. J Pediatr Ophthalmol 15:318-320, 1978. Diplopia and restriction of voluntary and involuntary elevation was noted to develop in three patients several weeks following blunt trauma to the orbit. None of the patients had orbital floor fractures. All did show fibrosis and adhesions to the inferior rectus and inferior oblique muscles. Treatment was surgical in all cases aiming to eliminate diplopia in the primary and reading positions. ROMEM M, GASUL Z: Simultaneous fourmuscle surgery in V-esotropia. J Pediatr Ophthalmol 15:5-7, 1978. The results of bilateral medial rectus recessions as a single procedure or in combination with bilateral inferior oblique recessions or myectomies were reviewed. Cases in which there was marked overaction of both
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inferior obliques obtained better results with simultaneous four-muscle surgery. However, in V-esotropia in which there was moderate overaction of the inferior obliques, satisfactory results were obtained with horizontal surgery alone. ROSENBAUM AL, WEISS SJ: Monozygotic twins discordant for Duane's retraction syndrome. J Pediatr Ophthalmol 15:359361, 1978. In a set of monozygotic twins only one was affected with Duane's retraction syndrome. Some of the theoretical problems which this situation produces are discussed. Complications at birth appears to be the least objectionable explanation for this occurrence. SCHECHTER RJ: Ptosis with contralateral lid retraction due to excessive innervation of the levator palpebrae superiorus. Ann Ophthalmol 10:1324-1328, 1978. Two case reports of patients with unilateral ptosis and contralateral lid retraction are presented. The author feels that, due to Hering's law, the excessive innervation supplied to the preferred, ptotic eye is transmitted to the opposite, non-preferred eye resulting in lid retraction. The author notes that if the ptotic lid is manually elevated the contralateral lid retraction decreases in seconds. He feels that this method for the evaluation of unequal ptosis is superior to the previously reported method of patching the ptotic eye. SETAYESH AR, KHODADOUsr AA, DARYANI SM: Microtropia. Arch Ophthalmol 96: 1842-1847, 1978. Fifty patients with microtropia, all of whom had some degree of anisometropia, were studied. Only two patients were found to have developed a microtropia after treatment for an -originally large angle of strabismus. The remaining 48 patients had primary microtropia. In almost all cases the amblyopic eye was the one with the greater refractive error. For this reason the authors feel that uncorrected anisometropia is the main factor causing foveal suppression in patients with primary microtropia. SHIPPMAN S, HERMANN JS: Antipodean squint. J Pediatr Ophthalmol 15:210-212, 1978.
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Three case reports are presented of patients who demonstrated an esotropia when fixating with one eye and an exotropia when fixating with the other eye. None of the patients had anisometropia, previous ocular muscle surgery, unequal accommodation, paralysis or restriction of an extraocular muscle, pseudoexotropia secondary to an ectopic macula or any pathology that could result in such a deviation. SINGH G, DAS PN: Pattern of amblyopia and fixation after keratoplasty. Br J Ophthalmol 62:29-33, 1978. The pattern of amblyopia and fixation was investigated in 40 cases of clear corneal grafts. The authors concluded that when an opacity is unilateral and arises before the age of five years and when corneal grafting is delayed until adulthood, a severe amblyopia develops. When the corneal opacities are bilateral, the amblyopia is not very dense and in at least one eye good visual improvement occurs after corneal grafting. When a corenal opacity develops after the age of seven it has no significant influence on the amblyopia or the fixation pattern, regardless of the interval between its development and surgery. SPECTOR RH, SMITH JL, CHAVIS PS: Charcot-Marie-tooth disease mimicking ocular myasthenia gravis. Ann Ophthalmol 10: 1033-1036, 1978. Intermittent ocular signs, often the presenting signs in myasthenia gravis, may represent the onset of chronic progressive external ophthalmoplegia (CPEO). A case report is presented in which CPEO is a complicating factor of Charcot-Marie-tooth disease. ThOBE JD, GLASER JS, QUENCER RC: Isolated oculomotor paralysis. Arch Ophthalmol 96:1236-1240, 1978. An isolated third nerve palsy is a common symptom in patients with aneurysms. In the majority of cases these aneurysms are located in the anterior circulation, usually at the junction of the internal carotid and posterior communicating arteries. Rarely have oculomotor palsies been described in connection with aneurysms of the posterior circulation. In this article two such cases are
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presented in which patients with aneurysms of the posterior circulation developed third nerve palsies. VON NOORDEN GK, MORRIS J, EDELMAN P: Efficacy of bifocals in the treatment of accommodative esotropia. Am J Ophthalmol 85:83a.834, 1978. Eighty-four patients with partially refractive, accommodative esotropia were treated with bifocals to assist in controlling their near deviations. Patients with high AC/ A ratios had the highest cure rate with respect to eventual control of the deviation without assistance from bifocals or surgery. Patients with low AC/ A ratios tended to be either totally dependent on the bifocals to help control their near deviation, or their control of the deviation deteriorated while under maximal bifocal therapy. WILLIAMS AT, METZ HS, JAMPOLSKY A: The O'Connor cinch revisited. Br J Ophthalmol 62:765-769, 1978. After performing an O'Connor cinch in 17 patients, the results were reviewed. An average of 4 mm of resection was obtained with the standard procedure which is described in the article. Adj usting some or all of the strands on the first postoperative day yielded a 106 to 206 reduction in the deviation. There was also an additional "stretching out" of the cinch effect for two to four weeks after adjustment. The authors felt that the O'Connor cinch is a useful, adjustable resection procedure that can be used in children as well as adults. WOOD ICJ, Fox JA, STEPHENSON MG: Contrast threshold of random dot stereograms in anisometropic amblyopia: a clinical investigation. Br J Ophthalmol 62:34-38, 1978. The contrast thresholds of random dot stereograms were studied in normal patients and in patients with anisometropic amblyopia. There was a marked elevation of the contrast threshold of both the sound eye and the amblyopic eye under binocular testing conditions when compared with the normal subjects. The elevation was also greater when alignment of the two fovea was poor. These findings suggested that the mechanism of amblyopia is due to a reduction in the number of functioning binocular cells.