Inferior Oblique Recession with 5 mm Loop to Correct Vertical Deviation and Inferior Oblique Overaction Secondary to Superior Oblique Palsy.

Purpose: To evaluate the effect of augmented inferior oblique recession (recession +5 mm loop) on the vertical deviation in primary position (PP) and the inferior oblique overaction (IOOA) in patients with unilateral congenital or acquired superior oblique palsy.Patients and methods: The medical records of patients who underwent unilateral inferior oblique recession with 5 mm loop during 2012 and 2019 were retrospectively reviewed. All patients had small to moderate manifest or intermittent hypertropia in PP and overaction of the inferior oblique muscle of +2 or +3 in lateral gaze. Patients who had combined inferior rectus surgery of the contralateral eye or who had previous vertical muscle surgery were excluded.Results: A total of 26 patients were included. Of these, three patients had combined horizontal muscle surgery. In 22 patients, the superior oblique palsy was congenital or longstanding, in 4 it was acquired and stable for more than 9 months. The mean preoperative vertical deviation in PP at distance and near was 14.7Δ and 11.2Δ, respectively. The mean postoperative vertical deviation was 5.7Δ and 4.1Δ after a mean follow-up of 19 months. The IOOA improved in all patients, 16 patients had an improvement of +2 and 10 patients had an improvement of +1.Conclusion: Inferior oblique recession with a 5 mm loop is a simple and quick technique to correct small to moderate hypertropia in primary position and inferior oblique overaction in contralateral gaze in patients with congenital, longstanding or acquired superior oblique palsy without risk of overcorrection.

[Advantages of the bag-in-the-lens intraocular lens in pediatric cataract surgery]. / Intérêt de l'implant "bag-in-the-lens" dans la chirurgie de la cataracte de l'enfant.

OBJECTIVE: Evaluate the advantages of the bag-in-the-lens intraocular lens in children undergoing cataract surgery. PATIENTS AND METHODS: This prospective study included 54 eyes of 37 children and babies (age, 2 months to 14 years), consecutively operated on between December 1999 and January 2008 for unilateral or bilateral cataract using the "bag-in-the-lens" intraocular lens. Slit-lamp examination, intraocular pressure, visual acuity, and refraction were followed to the best possible degree over time. RESULTS: The mean age of the 37 children at the last consultation visit was 8.3+/-4.9 years. The mean visual acuity improved from 0.2+/-0.1 to 0.8+/-0.3. On the other hand, visual acuity improvement in children presenting hyperplastic persistence of the vitreous was less favorable with a postoperative average visual acuity of 0.14+/-0.18. The mean postoperative refraction in 13 children (26 eyes) operated on for bilateral cataract was 0.5+/-1.5 D for eyes showing axial lengths with substantial variation. The refraction was stable over time in children over 2 years of age. Once the implant was positioned correctly, the remaining epithelial cells of the lens did not migrate toward the visual axis, which was the case in 93.8% of all eyes and in 100% of children over 1 year of age. CONCLUSIONS: The "bag-in-the-lens" implant is particularly indicated in children in whom posterior rhexis and optic capture have been recommended since 1994. The implantation minimizes the use of anterior vitrectomy in pediatric cataract surgery, limiting it to those eyes presenting a proliferative hyperplastic vitreous.

Effect of refractive surgery on binocular vision and ocular alignment in patients with manifest or intermittent strabismus.

OBJECTIVE: To evaluate the effect of refractive surgery on binocular vision and ocular alignment in patients with manifest or intermittent strabismus, with or without vertical component. SETTING: University Hospital Antwerp, Edegem, Belgium. PATIENTS AND METHODS: 13 patients (22 eyes) with strabismus underwent refractive surgery. Five of these patients presented with an esotropia and four of them with a small vertical deviation. Five patients had a manifest exotropia, of whom two presented with a small vertical deviation. Two patients had an intermittent exotropia with binocular vision, of whom one patient had a vertical deviation. One patient had a hypertropia with a dissociated vertical deviation. RESULTS: Ocular alignment and binocular function remained unchanged postoperatively in all except two patients with high anisometropia who experienced an improvement in binocular function. In these patients, the preoperative manifest deviation became intermittent or latent after surgery, allowing fusion and stereopsis. Vertical deviation was found preoperatively in 8 of the 13 patients. This vertical deviation remained unchanged postoperatively, but improved in one patient with anisometropia. CONCLUSION: Preoperative intermittent or manifest strabismus is not a contraindication for refractive surgery provided some specific recommendations are taken into account, such as an adequate preoperative orthoptic examination and aiming at emmetropia for both eyes.

Cyclic esotropia and the treatment of over-elevation in adduction and V-pattern.

AIM: To describe the development and treatment of V-pattern and bilateral over-elevation in adduction in patients with cyclic esotropia. METHODS: Three patients with cyclic esotropia are described in retrospect. All patients underwent bilateral medial recession, while one patient additionally had a weakening procedure of both inferior oblique muscles. RESULTS: All patients developed a V-pattern and bilateral over-elevation in adduction. After strabismus surgery, normal eye alignment with some signs of binocularity was reached in all three patients. Moreover, the over-elevation in adduction and V-pattern completely resolved. CONCLUSIONS: V-pattern and bilateral over-elevation in adduction was seen in all patients with cyclic esotropia in the stage that fusion was disrupted. Possible explanations for the origin of these patterns are discussed. Strabismus surgery aimed to correct the horizontal esotropic angle restored fusion and eliminated the vertical incommitancies in lateral gaze, and the V-pattern.

Combined fourth and sixth cranial nerve palsy after lumbar puncture: a rare complication. A case report.

Palsies of cranial nerves are well-known complications after lumbar puncture. Sixth nerve palsies are the most common. They normally occur 4 to 14 days after the lumbar puncture and spontaneously recover in a few weeks or months. The occurrence of a fourth nerve palsy following lumbar puncture however is extremely rare. We report on a patient who developed a combined contralateral fourth and sixth nerve palsy after lumbar puncture (Syndrome of Intracranial Hypotension), requiring surgical correction for secondary diplopia.

Diagnosis of a masked bilateral congenital superior oblique palsy.

Some patients in whom the diagnosis of a purely unilateral congenital superior oblique palsy was made, developed signs of a palsy in the fellow eye after surgery was done. A review of all diagnostic tests used in discovering the presence of a masked bilateral superior oblique palsy is given. The usefulness of the occlusion-test, which is often forgotten, is illustrated.