A suspected case of anesthesia-induced rhabdomyolysis in a child undergoing strabismus surgery.

We report a case of acute rhabdomyolysis following general anesthesia for strabismus surgery in a previously healthy 11-year-old girl. The patient received a depolarizing muscle relaxant (succinylcholine) and halogenated volatile anesthetic agent (sevoflurane) during surgery. In rare cases, these classes of drugs can trigger malignant hyperthermia (MH) or anesthesia-induced rhabdomyolysis (AIR), which can cause significant morbidity and mortality if not recognized and treated promptly. Pathophysiology, early recognition, and special considerations in strabismus patients are discussed.

Surgical implications of the superior oblique frenulum.

BACKGROUND: The superior oblique frenulum is a fascial membrane that prevents substantial separation of the superior rectus muscle and SO tendon. METHODS: In three patients, the superior rectus muscle was disinserted and temporarily suspended 6, 8, 10, 12, and 14 mm in random order from its insertion. The change in position of the anterior edge of the superior oblique tendon from the superior rectus muscle insertion was measured before and after severing the frenulum structure. In four other patients undergoing superior oblique recession, the superior oblique tendon was disinserted at its insertion temporally. The amount of recession that spontaneously occurred was measured before and after severing the frenulum. RESULTS: In the first group, there was essentially a one-to-one correlation between the posterior movement of the superior oblique tendon and the amount of superior rectus recession for recessions up to 10 mm. After severing the frenulum, the anterior portion of the superior oblique tendon was positioned less posteriorly. It measured less than 1.2 mm for superior rectus recessions up to 14 mm. For the second group, the mean suspension distance of the cut end of the disinserted superior oblique tendon was 2.4 +/- 0.4 mm before stripping the frenulum as compared with 8.5 +/- 0.7 mm after stripping the frenulum (Student's t-test, p = 0.0011). CONCLUSIONS: The frenulum pulls the superior oblique tendon posteriorly as the superior rectus muscle is recessed and constrains the superior oblique tendon after disinsertion. How this connection is handled at the time of surgery may have implications for superior rectus recessions and superior oblique tendon surgery.

Modified cataract surgery with telescopic magnification for patients with age-related macular degeneration.

BACKGROUND: The most desirable effect following cataract surgery in the presence of age-related macular degeneration (AMD) is to obtain an improvement in distance resolution acuity, and the only optical solution to this is the use of telescopic magnification. The purpose of the study was to develop and verify the clinical utility of inducing low-grade telescopic magnification (<33%) at the time of cataract surgery by the choice of an appropriate intraocular lens power and spectacle glasses in patients with AMD and cataract. METHODS: The design was a prospective, nonrandomized, interventional case series involving 6 patients aged 74-86 (mean 80; SD 4) years with AMD and cataract. Participants were males and females, equal in number, who had visual acuity of less than 20/400 in the weaker eye. Standard cataract surgery was performed in the weaker eye. The power of the intraocular lens was derived from the reduced Gullstrand model of the eye in such a way that at the intraocular lens plane a minus lens was created, which, together with a plus lens in matching glasses, formed a Galilean telescopic system with magnification of up to 33%. Outcome measures were visual acuity, contrast sensitivity, and activities of daily living (ADL) scores. RESULTS: The mean power of the implanted intraocular lenses was 6.31 (SD 2.42) diopters and, according to the theoretical derivations, achieved magnification between 20% and 30% (mean 26%; SD 4.92%). Visual acuity improved for the group from a mean of 20/525 (logMAR 1.48; SD 0.13) to a mean of 20/290 (logMAR 1.20; SD 0.21). Contrast sensitivity improved significantly (p < 0.001) only in the lower spatial frequencies. Postoperatively, ADL scores improved significantly in all patients except one. At the end of the follow-up period, 3 patients reported that they would like to proceed with similar surgery for the other eye. INTERPRETATION: An optimal surgical telescopic device based on low-grade telescopic magnification may improve functional vision for usage in all tasks in AMD patients. All patients from this study were satisfied following surgery and viewed study outcomes as positive and beneficial, and some patients responded with enthusiasm. Surgeons are encouraged to use this modified technique of cataract surgery in low-vision patients with AMD and cataract.