Purpose: Strabismus occurring after scleral buckling for retinal detachment typically is attributed to scarring, but this is not the only mechanism. We investigated use of magnetic resonance imaging (MRI) to identify ...Purpose: Strabismus occurring after scleral buckling for retinal detachment typically is attributed to scarring, but this is not the only mechanism. We investigated use of magnetic resonance imaging (MRI) to identify a spectrum of mechanisms of strabismus occurring after scleral buckling. Design:Prospective, noncomparative, observational case series in an academic referral setting. Participants: Six patients with longstanding, large- angle strabismus after monocular or binocular scleral buckling. Horizontal and vertical preoperative deviations, present from 8 to 120 months, ranged from 25 prism diopters to more than 90 prism diopters. Methods: Multipositional high- resolution- MRI of both orbits was performed using surface coils in multiple, controlled gaze positions. Coronal, sagittal, and axial images were obtained as clinically appropriate. Main Outcome Measures: Different mechanisms of pathologic characteristics of the extraocularmuscles (EOMs) in complicated strabismus after scleral buckling. Results: Magnetic resonance imaging readily demonstrated EOM size and contractility, as well as features of scleral buckle hardware such as grooves and junctions and relationships of EOMs to the buckle and sclera. Imaging demonstrated that 5 rectus EOMs were disinserted from the globe at the buckle: 2 superior rectus, 2 medial rectus, and 1 lateral rectus. One patient with suspected inferior rectus muscle disinsertion had restrictive strabismus as a result of interference by a meridional explant and myopic staphyloma. Magnetic resonance imaging demonstrated anterior migration and transection by the silicone element through rectus EOMs in 3 patients. Disinserted EOMs were retrieved successfully by transconjunctival surgery in 4 patients and by orbitotomy in 1 patient, markedly improving alignment even as long as 5 years after EOM disinsertion. Conclusions: Multipositional high- resolution MRI provides valuable information such as location and contractile potential of disinserted EOMs, as well as mass effect from the scle展开更多
Purpose:To observe the form and number of the anterior ciliary vessels(ACV)in rectus muscles.To train technician in preservation an d obsevation of ACV,so preservation can be done in caes with a rish of anterior segm...Purpose:To observe the form and number of the anterior ciliary vessels(ACV)in rectus muscles.To train technician in preservation an d obsevation of ACV,so preservation can be done in caes with a rish of anterior segment ischemia(ASI).Methods:Curved foreign knife,iris hook,plastic rubber band and standard operat-ing loupes(3x)or microscope were used in the surgery on 34cases of comitant strabismus and 18cases of paralytic strabismus.Results:The ACVs per muscle in medial,lateral,superior,inferior rectus were3.08,3.26,3.50and3.50respectively in 89muscles of 52surgical strabismus cas-es.All ACVs in 16rectus muscles and 90out of 220ACVs in 73rectus muscles were too small ortoo short to be dissected.The sucess rate of ACV preservation was91.5%(119/130).105out of 130vessels were saved using loupe magnifica-tion and 14pit pf130vessels were saved under operating microscope.Conclusions:The number of ACVinrectus muscles are more than 2in our obser-vation cases.The ACVpreservation has the clinical value of allowing us toper-form muscle sugery on three or more rectus muscles simultaneously and get fonal surgical results more earlier after acv in each muscle are dissected and preserved otherwinse staged surgery are needed.The each strabismus surgeon must knov this technique.展开更多
The purpose of this report is to characterize the clinical and electrophysiolo gical effects of extraocular muscle surgery in 15 patients with oculo-cutaneous albinism (OCA) and infantile nystagmus syndrome (INS). Our...The purpose of this report is to characterize the clinical and electrophysiolo gical effects of extraocular muscle surgery in 15 patients with oculo-cutaneous albinism (OCA) and infantile nystagmus syndrome (INS). Our hypothesis is that s urgery on the extraocular muscles of patients with OCA and INS changes their nys tagmus and their visual function. Interventional, prospective, cohort, noncompar ative case series. All 15 patients had surgery on all four virgin horizontal rec ti; three for strabismus alone, three for nystagmus alone, five for an eccentric gaze null zone alone, and four for an eccentric gaze null zone plus strabismus. All patients have been followed for at least six months. All 15 patients had th e subjective outcome measure of pre-and postoperative binocular best optically corrected acuity (BBOCA). Objective outcome measures included anomalous head pos ture (AHP) in nine patients, eye movement recording measures of expanded nystagm us acuity function (NAFX) in 10 patients, null zone position (NUZP) and null zon e width (NUZW) in 10 patients, and foveation time (FOV) in nine patients. The re sults are summarized as follows; BBOCA increased 0.1 LogMar or greater in 14 of 15 patients. In those operated on for an AHP with or without associated strabism us the AHP improved significantly (P< . 01 for all)-.The NAFX, NUZP, NUZW, and FOV measured from eye movement recordings showed persistent, significant increas es in all patients (P < . 01 for all). This report adds to the evidence that sur gery on the extraocular muscles in patients with INS has independent neurologic and visual results.展开更多
文摘Purpose: Strabismus occurring after scleral buckling for retinal detachment typically is attributed to scarring, but this is not the only mechanism. We investigated use of magnetic resonance imaging (MRI) to identify a spectrum of mechanisms of strabismus occurring after scleral buckling. Design:Prospective, noncomparative, observational case series in an academic referral setting. Participants: Six patients with longstanding, large- angle strabismus after monocular or binocular scleral buckling. Horizontal and vertical preoperative deviations, present from 8 to 120 months, ranged from 25 prism diopters to more than 90 prism diopters. Methods: Multipositional high- resolution- MRI of both orbits was performed using surface coils in multiple, controlled gaze positions. Coronal, sagittal, and axial images were obtained as clinically appropriate. Main Outcome Measures: Different mechanisms of pathologic characteristics of the extraocularmuscles (EOMs) in complicated strabismus after scleral buckling. Results: Magnetic resonance imaging readily demonstrated EOM size and contractility, as well as features of scleral buckle hardware such as grooves and junctions and relationships of EOMs to the buckle and sclera. Imaging demonstrated that 5 rectus EOMs were disinserted from the globe at the buckle: 2 superior rectus, 2 medial rectus, and 1 lateral rectus. One patient with suspected inferior rectus muscle disinsertion had restrictive strabismus as a result of interference by a meridional explant and myopic staphyloma. Magnetic resonance imaging demonstrated anterior migration and transection by the silicone element through rectus EOMs in 3 patients. Disinserted EOMs were retrieved successfully by transconjunctival surgery in 4 patients and by orbitotomy in 1 patient, markedly improving alignment even as long as 5 years after EOM disinsertion. Conclusions: Multipositional high- resolution MRI provides valuable information such as location and contractile potential of disinserted EOMs, as well as mass effect from the scle
文摘Purpose:To observe the form and number of the anterior ciliary vessels(ACV)in rectus muscles.To train technician in preservation an d obsevation of ACV,so preservation can be done in caes with a rish of anterior segment ischemia(ASI).Methods:Curved foreign knife,iris hook,plastic rubber band and standard operat-ing loupes(3x)or microscope were used in the surgery on 34cases of comitant strabismus and 18cases of paralytic strabismus.Results:The ACVs per muscle in medial,lateral,superior,inferior rectus were3.08,3.26,3.50and3.50respectively in 89muscles of 52surgical strabismus cas-es.All ACVs in 16rectus muscles and 90out of 220ACVs in 73rectus muscles were too small ortoo short to be dissected.The sucess rate of ACV preservation was91.5%(119/130).105out of 130vessels were saved using loupe magnifica-tion and 14pit pf130vessels were saved under operating microscope.Conclusions:The number of ACVinrectus muscles are more than 2in our obser-vation cases.The ACVpreservation has the clinical value of allowing us toper-form muscle sugery on three or more rectus muscles simultaneously and get fonal surgical results more earlier after acv in each muscle are dissected and preserved otherwinse staged surgery are needed.The each strabismus surgeon must knov this technique.
文摘The purpose of this report is to characterize the clinical and electrophysiolo gical effects of extraocular muscle surgery in 15 patients with oculo-cutaneous albinism (OCA) and infantile nystagmus syndrome (INS). Our hypothesis is that s urgery on the extraocular muscles of patients with OCA and INS changes their nys tagmus and their visual function. Interventional, prospective, cohort, noncompar ative case series. All 15 patients had surgery on all four virgin horizontal rec ti; three for strabismus alone, three for nystagmus alone, five for an eccentric gaze null zone alone, and four for an eccentric gaze null zone plus strabismus. All patients have been followed for at least six months. All 15 patients had th e subjective outcome measure of pre-and postoperative binocular best optically corrected acuity (BBOCA). Objective outcome measures included anomalous head pos ture (AHP) in nine patients, eye movement recording measures of expanded nystagm us acuity function (NAFX) in 10 patients, null zone position (NUZP) and null zon e width (NUZW) in 10 patients, and foveation time (FOV) in nine patients. The re sults are summarized as follows; BBOCA increased 0.1 LogMar or greater in 14 of 15 patients. In those operated on for an AHP with or without associated strabism us the AHP improved significantly (P< . 01 for all)-.The NAFX, NUZP, NUZW, and FOV measured from eye movement recordings showed persistent, significant increas es in all patients (P < . 01 for all). This report adds to the evidence that sur gery on the extraocular muscles in patients with INS has independent neurologic and visual results.
