By Marc H. Gobin M.D., Ph.D., Jos J. M. Bierlaagh D.B.O.(T.) (auth.)
Thirty years in the past, our awareness used to be attracted to the alphabetical incom itances in strabismus. As an elevation in adduction is the main widespread incomitance, we determined to begin treating those incomitances. A vulnerable ening approach of the inferior indirect muscle appeared indicated. How ever, considering we needed to avoid a torsional overcorrection with a head tilt, we displaced the scleral insertion of the indirect muscle in the direction of the equator of the globe. this manner, the torsional motion of the muscle mass is kept. A weakening of the horizontal rectus muscle mass was once systematically further, making it a simultaneous horizontal and cyclovertical surgical procedure. Our approach to care for strabismus constructed right into a coherent entity and the curiosity of comrades inspired us to write down it down.We made up our minds to submit a textbook with a theoretical and an intensive sensible half. Our procedure is predicated on thirty years of specific strabological paintings, half-time educational and half-time inner most perform. greater than 6500 re sults have been analysed and the bulk were released. The con cerned courses are mentioned on the finish of the 1st bankruptcy. deepest perform allowed to learn from the truth that sufferers have been operated on by way of a similar general practitioner and remained in own touch in the course of follow-up.
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Additional resources for Simultaneous Horizontal and Cyclovertical Strabismus Surgery
Sample text
II 45a The elevation in adduction of the left eye has disappeared. ~ ~ r:El ~ + + + 1+ f$l IT] + 1+ ~ + nl lTI GEl ~ Fig. II 45b The elevation j,n adduction is even transformed into a depression in adduction. In the first example, the elevation in adduction from the left eye has disappeared and in the second one it is even transformed into a depression in adduction. This combination is often observed in a bilateral- but asymmetrical - palsy of the superior oblique muscle. The most affected oblique muscle masks the paresis of the other oblique muscle, which only becomes apparent after surgery of the former.
A depression in adduction may be concealed in a large esotropia and appear after the esotropia has been reduced, whereas an elevation in adduction may seem absent in exotropia and become visible after correction of the exotropia. 9. To reveal incomitances, the eyes need to be dissociated completely. It may be necessary to occlude one eye for a week to dissociate the eyes maximally. Ocular movements should then be examined immediately after the cover is removed to prevent the fusion reflexes from compensating the incomitances.
When the size of the scotoma decreases and centres symmetrically around the fovea, orthophorisation can be expected. 3. When the scotoma spreads towards the temporal hemiretina, there is a tendency for overcorrection. 4. When the scotoma shifts towards the temporal hemiretina and, in addition, disappears from the nasal hemiretina, a consolidation of the overcorrection is likely. Whenever the parents ask whether there is stereopsis, the Lang two-pencil test** is performed (Figures II. 25 a,b). It is an excellent test and has the distinct advantage of being very demonstrative.