Phenotypic Plasticity, Epigenetic or Genetic Modifications in Relation to the Duration of Cd-Exposure within a Microevolution Time Range in the Beet Armyworm.

In the case of the pests inhabiting metal polluted or fields where the use of pesticides is common, a natural selection of resistant individuals can occur. This may pose serious problems for humans, agriculture, as well as the economies of many countries. In this study, the hypothesis that multigenerational (120 generations) exposure to cadmium of a beet armyworm population could be a selecting factor toward a more efficient DNA protection was verified. The hemocytes of individuals from two culture strains (control and Cd-exposed) were treated with H2O2 (a DNA-damaging agent) or PBS (reference). The level of DNA damage was assessed using the Comet assay immediately and 5, 15 and 30 min. after the treatment. The immediate result of the contact with H2O2 was that the level of DNA damage in the hemocytes of the insects from both strains increased significantly. However, in the cells of the Cd-exposed individuals, the level of DNA damage decreased over time, while in the cells from the control insects it remained at the same level with no evidence of repair. These results suggest that efficient defense mechanisms may exist in the cells of insects that have prolonged contact with cadmium. Some evolutionary and trade-off aspects of the phenomenon are discussed. In a wider context, comparing the results obtained in the laboratory with field studies may be beneficial for understanding basic mechanisms of the resistance of an organism. To summarize, the high potential for the repair of DNA damage that was observed in the insects from the cadmium strain may confirm the hypothesis that multigenerational exposure to that metal may possibly contribute to the selection of insects that have a wider tolerance to oxidative stress. However, our investigations of polymorphism using AFLP did not reveal differences between the two main insect strains.

Evaluation of the complex treatment for congenital blepharoptosis.

OBJECTIVE: To evaluate the results of treatment of congenital blepharoptosis (CBP) using selected surgical methods; and to evaluate concomitant visual system disorders. METHODS: Between 2001 and 2010, 52 children with CBP underwent surgical correction of CBP using the modified method of Mustarde, the original Mustarde method or frontal suspension at the Department of Plastic Surgery, Medical University of Lodz (Poland). Based on the results of ophthalmic and orthoptic examination, and standard measurements, postoperative differences in the position and symmetry of the upper eyelids, complications, and visual system abnormalities were analyzed. RESULTS: Very good results were obtained in all patients with mild unilateral CBP. The results in patients with moderate and severe unilateral CBP, and in bilateral anomaly after correction using Mustarde's method or the modified Mustarde's method, were also very good. Complications included lagophthalmos (15.4%) and undercorrection (3.8%). Visual system disorders, mainly amblyopia, resulting from strabismus, astigmatism, anisometropia and CBP, were observed in 88.5% of patients. CONCLUSIONS: Complex ophthalmic examination and measurements in individuals with CBP enable correct diagnosis, selection of appropriate treatment method and timing of surgical intervention. Postoperative results in patients with CBP supported the efficacy of the methods that shortened the levator palpebrae superioris. Supplementing with Mustarde's modified method contributed to an increase in the number of favourable postoperative results.

OBJECTIF: Évaluer les résultats du traitement de la blépharoptose congénitale (BPC) à l'aide de certaines méthodes chirurgicales et évaluer les troubles du système visuel s'y associant. MÉTHODOLOGIE: Entre 2001 et 2010, 52 enfants ayant une BPC ont subi une correction chirurgicale au moyen de la méthode modifiée de Mustarde, de la méthode originale de Mustarde ou de la suspension aux muscles frontaux au département de chirurgie plastique de l'université médicale de Lodz, en Pologne. D'après les résultats de l'examen ophtalmique et orthoptique et les mesures standards, les chercheurs ont analysé les différences postopératoires dans la position et la symétrie des paupières supérieures, les complications et les anomalies du système visuel. RÉSULTATS: Tous les patients ayant une BPC unilatérale bénigne ont obtenu de très bons résultats. Ceux dont la BPC unilatérale était modérée ou grave ou dont l'anomalie était bilatérale ont également obtenu de très bons résultats après correction par la méthode de Mustarde classique ou modifiée. La lagophtalmie (15,4 %) et la sous-correction (3,8 %) faisaient partie des complications. Les chercheurs ont observé des troubles du système visuel chez 88,5 % des patients, notamment l'amblyopie, causés par un strabisme, un astigmatisme, une anisométropie ou une BPC. CONCLUSIONS: Chez les enfants ayant une BPC, un examen ophtalmique approfondi et des mesures favorisaient un bon diagnostic, le choix de la méthode thérapeutique appropriée et la sélection du bon moment pour effectuer l'intervention chirurgicale. Les résultats postopératoires chez les patients ayant une BPC corroboraient l'efficacité des méthodes visant à raccourcir le muscle releveur de la paupière supérieure. L'ajout de la méthode modifiée de Mustarde contribuait à accroître le nombre de résultats postopératoires favorables.

Visual outcomes, binocular vision and subjective accommodation after Crystalens HD accommodating intraocular lens implantation. / [Ocena ostrosci wzroku, widzenia obuocznego i subiektywnej akomodacji po wszczepieniu soczewek akomodacyjnych Crystalens HD].

Objective: To evaluate visual acuity, binocular vision and subjective accommodation in patients after Crystalens HD accommodating intraocular lenses (IOLs) or monofocal IOLs implantation. Material and methods: 75 consecutive patients (aged 48 to 75 years) after bilateral cataract surgery with acrylic monofocal IOL (n = 36) or single-optic accommodating IOL (Crystalens HD) (n = 19) implantation and healthy presbyopic population (n = 20) were enrolled. Presence of asthenopic symptoms, diplopia and spectacle dependence was assessed. Orthoptic status, prism bar and amblyoscopic motor fusion, Frisby Near Stereotest, TNO and Titmus tests were performed. Convergence and subjective accommodation were evaluated using Krimsky-Prince rule. Results: Asthenopic symptoms were present respectively in 36.1%, 15.8% and 35.0% of patients and spectacle dependency was reported by 86.1%, 21.1% and 85.0% of patients in subsequent groups. Negative fusional distance vergence means were 9.53 ± 5.53, 8.05 ± 3.66, 6.65 ± 5.33 respectively (p = .039). Negative fusional near vergence means were 26.53 ± 11.39, 28.68 ± 11.70, 20.75 ± 12.60 in subsequent groups (p = .001). Mean subjective right eye/ left eye accommodation was 5.01 ± 1.47/ 4.86 ± 1.72, 6.29 ± 2.33/ 6.02 ± 1.90, 4.13 ± 0.89/ 4.22 ± 1.3 respectively (p = .009). There were no statistically significant differences between groups in positive fusional vergence, stereoacuity and near point of convergence. Conclusions: Bilateral accommodating IOL implantation provided full binocular vision in the majority of patients. Spectacle dependence and asthenopic symptoms were less frequent in patients with accommodating IOLs. Accommodating IOLs provided significantly better useful accommodation than monofocal IOLs.

[Large hang-back recession of superior rectus muscles as effective treatment of patients with dissociated vertical deviation]. / Duza recesja miesni prostych górnych technika "hang-back" jako skuteczna metoda leczenia pacjentów ze zdysocjowanym odchyleniem pionowym.

PURPOSE: The aim of this study is to report the results of large bilateral superior rectus hang-back recession in patients with dissociated vertical deviation. MATERIAL AND METHODS: Retrospective analysis of patients with dissociated vertical deviation treated in the Department of Ophthalmology between 2011 and 2013. Our enrolment criteria included vertical strabismus angle over 15Δ and the absence of inferior or superior oblique overaction in patients who underwent bilateral superior rectus recession ranging from 8 mm to 12 mm. The surgical outcomes were evaluated. RESULTS: Nine patients at the age of 14 to 46 years were included in the study. The mean vertical angle of deviation in the non-dominant eye was 22.8Δ ± 5.3Δ. The mean amount of recession was 9.8 ± 1.4 mm. CONCLUSIONS: Large bilateral hang-back recession of the superior rectus muscles effectively reduces the vertical angle in patients with dissociated vertical deviation without concomitant oblique muscle overaction. dissociated vertical deviation (OVO), strabismus surgery, large recession of superior rectus muscles.

Surgical management of upgaze diplopia in patients after posttraumatic orbital floor reconstruction.

OBJECTIVE: The most common complication of otherwise successful reconstructive surgery of a fractured orbital floor is persistent diplopia. For patients with troublesome double vision in upgaze, a reasonable solution is offered by strabismus surgery. The aim of our study is to examine the results of extraocular muscle surgery in cases of diplopia that persisted in upgaze after posttraumatic orbital floor reconstruction. MATERIAL AND METHODS: In this study we present a retrospective series of 24 patients with troublesome vertical diplopia in upgaze. In all cases, the surgery consisted of a posterior fixation suture placement on the contralateral superior rectus muscle with or without its recession. Full orthoptic examination was conducted before and 3 months after the surgery. RESULTS: Postoperatively 19 patients (79%) were diplopia free and 6 (21%) had vertical diplopia in extreme upgaze. The field of binocular single vision improved threefold. None of the patients reported diplopia in the primary position or in any position other than upgaze. CONCLUSION: Vertical incomitant strabismus and diplopia in upgaze persisting after orbital reconstructive surgery may be corrected surgically. Contralateral posterior fixation of the superior rectus muscle, with or without its recession, appears to be an effective procedure for use in these patients.

Morphometric parameters of extraocular rectus muscles evaluated by dynamic-multipositional magnetic resonance.

PURPOSE: To establish normal values of morphologic parameters of extraocular rectus muscles visualized in different gaze positions by means of an accessible method of dynamic-multipositional magnetic resonance imaging (dmMRI). METHODS: Twenty eyes of 10 healthy, orthotropic subjects were examined. A 1.5T scanner (Avanto) with standard head coil was used. The protocol of dmMRI included 6 gaze positions in 10° intervals in which 13-second, orbital, T2 sequences were performed in quasi-coronal plane. The measurements of extraocular rectus muscles shape, sectional area, and volume were obtained with use of ImageJ 1.38x (NIH) software. RESULTS: Relative change in cross-sectional area between position of rest and gaze of action of each muscle appears to be significant just in the medial and posterior parts of their belly. The maximal cross-section area increases significantly when the muscle contracts (21% to 32% depending on the muscle). The superior rectus must be assessed along with levator palpebrae as the distinction between their bellies is difficult. Relative change in partial muscle volume on contraction ranged from 12.3% to 21.6% depending on the muscle. Muscle contraction results in more circular shape of its belly while relaxation is more of an ellipse. CONCLUSIONS: Dynamic-multipositional MRI performed in the proposed manner is an accessible and repeatable method for visualization of extraocular rectus muscles. Assessment of morphometric parameters such as muscle shape, maximal cross-section area, and partial muscle volume is easy with digital imaging software.

The influence of a prolonged interoperative period on binocular vision after bilateral cataract extractions.

PURPOSE: To evaluate the influence of the extent of the interoperative period on binocular vision function in patients after consecutive bilateral cataract extractions and intraocular lens implantation. METHODS: The study included patients operated due to bilateral cataract. Presence of asthenopic symptoms, distance and near squint angle, fusional amplitudes, stereopsis, and convergence were evaluated. Preoperative, interoperative, and postoperative differences in best-corrected visual acuity between eyes were also noted. Multivariate analysis was conducted in order to establish the relation between the interoperative period and binocular status. RESULTS: The study included 104 patients (74 female, 30 male, mean age 69.9 years, range 32-88). Mean interoperative period was 20.3 ± 12.9 months, range 1.5-47.7. Prolongation of the interoperative interval had a significant negative impact on stereopsis measured by TNO (R2 = 0.215, p = 0.001) and Randot (R2 = 0.179, p = 0.001) stereotests, as well as for near point of convergence (R2 = 0.09, p = 0.002). It was also related, but not independently, to reduction in fusional amplitudes, mainly for distance (R2 = 0.18, p = 0.001 for divergence and R2 = 0.12, p = 0.001 for convergence). Asthenopic symptoms were reported by 17 (16.3%) patients. The incidence of exophoria was significantly (p = 0.002) higher in patients with an interoperative interval longer than 24 months. CONCLUSIONS: The length of the interoperative period influences the status of binocular vision in patients after bilateral cataract extraction. It is also connected with an increased number of patients with asthenopic symptoms and exophoria.

Is binocular vision worth considering in people with low vision?

In someone with good vision, binocular vision provides benefits which could not be obtained by monocular viewing only. People with visual impairment often have abnormal binocularity. However, they often use both eyes simultaneously in their everyday activities. Much remains to be known about binocular vision in people with visual impairment. As the binocular status of people with low vision strongly influences their treatment and rehabilitation, it should be evaluated and considered before diagnosis and further recommendations.

[Difficulties in surgical management of consecutive exotropia]. / Trudnosci w chirurgicznym leczeniu zeza rozbieznego nastepczego.

Difficulties in surgical management of consecutive exotropia. Consecutive exotropia occurs in formerly esotropic patients without binocular vision, either spontaneously or as a result of surgical overcorrection. However, the above cannot provide sufficient explanation in all cases. Patients with consecutive exotropia mostly complain about aesthetic considerations, although a numerous group of patients reports disturbing diplopia. Patients with consecutive exotropia require particular attention of the surgeons, due to the difficulties in pre-operative assessment and, in turn, in planning thesurgery. The prism adaptation test and botulinum toxin injection used in pre-operative diagnostic assessment often fail to provide the fully reliable information concerning the potential cortical vision suppression, anomalous retinal correspondence and the risk of postoperative diplopia (including paradoxical diplopia). Moreover, many surgeons emphasize the role of technical difficulties experienced during the surgery performed in patients with consecutive exotropia, especially during the reoperation. The preoperative assessment in these patients must include the forced duction test in order to determine which eye should actually be addressed during the surgery. The ocular muscle strength must be balanced during the reoperation, which requires extensive surgical experience and often also the intraoperative adjustment of the primary surgical plan. However, listening patients' concerns regarding satisfactory aesthetic results and considering the risk of postoperative diplopia still remain of the utmost importance.

Management of persistent diplopia after surgical repair of orbital fractures.

PURPOSE: To present the results of management of patients with persistent diplopia after orbital reconstructive surgery with respect to the type of ocular motility impairment pattern. METHODS: All patients referred during a 2-year period because of persistent diplopia after surgical repair of orbital fracture were categorized according to the degree and pattern of ocular motility impairment on the basis of orthoptic examination 3-4 weeks postoperatively. Patients were followed for a mean period of 10.5 months (range, 6-12 months), during which adequate treatment was implemented. RESULTS: A total of 52 patients were included in the study (45 males; mean age, 41.8 ± 16.6 years). Most could be divided into 1 of 4 groups according to the type of ocular motility impairment. The follow-up orthoptic examination revealed resolution of diplopia in 9 patients (15%) and persistent but unbothersome diplopia in 26 (43.4%). Significant diplopia was treated conservatively in 3 patients (5%) and with strabismus surgery in 14 (23.3%) cases. CONCLUSIONS: The results of this study indicate that in most cases of persistent diplopia after reconstructive surgery for orbital fractures, symptoms resolve over time without treatment; nevertheless, strabismus surgery is unavoidable in some cases.

[The influence of sensory deprivation on binocular vision after bilateral cataract extraction with intraocular lens implantation]. / Wplyw deprywacji sensorycznej na widzenie obuoczne u pacjentow po obustronnej operacji zacmy z wszczepieniem soczewek wewnatrzgalkowych.

PURPOSE: Cataract extraction with intraocular lens implantation is one of the most frequent surgical procedures. However, benefits associated with the surgery may be restricted by binocular vision disorders. The purpose of the study is to evaluate binocular function of vision in patients after bilateral cataract extraction in relation to the length of period between surgeries. MATERIAL AND METHODS: The study included 50 patients operated twice, due to bilateral cataract. All patients were examined six weeks after the second surgery and divided into three groups according to the operational interval (< 12 months, 12-24 months, > 24 months). Presence of asthenopic symptoms, distance and near squint angle, fusional amplitudes, stereopsis and convergence were evaluated. RESULTS: Asthenopic symptoms were present respectively in 8% (n = 1), 42% (n = 8), 37% (n = 7) of patients in groups 1, 2 and 3. Exophoria was found in 16.6% (n = 2) of cases in the first group, 17.5% (n = 3) in the second group and 31.6% (n = 6) in the third group. There was no significant difference in average prismatic fusional vergence range between groups and a negative correlation between amblyoscopic fusional convergence and the period between surgeries was found. Mean stereopsis was 76.7 +/- 62.1; 89.5 +/- 66,2; 76.8 +/- 66.7 seconds of arc in subsequent groups. Average convergence was: 6.8 < or = 6.9 cm in the first group, 7.1 +/- 3.9 cm in the second group and 7.5 +/- 5.0 cm in the third group. CONCLUSIONS: There are significant differences in binocular vision parameters in patients after bilateral cataract extraction in relation to the period between surgeries. The prolongation of this time was connected with increased number of patients complaining to asthenopic symptoms, with exophoria and reduced amblyoscopic fusional convergence.

[Diplopia as a factor influencing occupational and social activities of people after orbital trauma]. / Dwojenie jako czynnik wplywajacy na aktywnosc spoleczna i zawodowa osób po przebytym urazie oczodolu.

BACKGROUND: Eye injuries are one of the most common sequelae of facial trauma. On the other hand extraocular muscle involvement entails the ocular motility disorders and double vision. The aim of this study was to assess the impact of orbital trauma on the social and professional activities of patients. MATERIALS AND METHODS: The material consisted of 44 patients after orbital trauma. The objective assessment of the ocular apparatus, especially eye alignment and subjective complaints was performed. All patients were interviewed with a questionnaire in order to assess the impact of visual disorders on daily, and socio-professional activities. RESULTS: The patients were mostly manual workers, living in urban areas, in whom assaults were the main cause of injury. Most of them showed good visual acuity, but 59% exhibited double vision. The ability to perform the former occupation was retained in 45.5% and 20.5% of workers could not perform the former job. Total or partial inability to work was certified in 23% of subjects. Orbital trauma also affected the functional vision of patients and decreased their quality of life; 30% of patients felt significant limitations in social function and 12% remained dependent on others for their daily activities. CONCLUSIONS: Orbital trauma and resulting double vision is an important factor influencing the professional activity. Double vision limits the ability to return to work, despite the lack of damage to the eyeballs and preserved good visual acuity. Orbital trauma causing diplopia does not significantly affect the social activities of the patients or their ability to drive.

Total ocular akinesis: Miller Fisher or Guillain-Barré syndrome?

Total, bilateral ophthalmoplegia is very rare. More than 50% of cases are Miller Fisher (MFS) and Guillain-Barré (GBS) syndromes. There is a correlation of MFS with anti-GQ1b antibodies. High levels of GQ1b gangliosides are found in myelin sheathes of cranial nerves supplying the extraocular muscles. This may explain the association of anti-GQ1b antibodies with ophthalmoplegia. Anti-GQ1b were also found in cases of GBS accompanied by ophthalmoplegia, atypical MFS (MFS without ataxia), MFS/GBS overlap syndromes and Bickerstaff brainstem encephalitis. This has led some authors to classify them as 'anti-GQ1b syndromes'. In this article we describe a diagnostically difficult case of a patient with a very rare, total bilateral paralysis of all ocular muscles, accompanied by bilateral ptosis, diminished tendon reflexes of upper extremities, paresis and hypoesthesia of the left upper extremity.

The use of modern imaging techniques in the diagnosis and treatment planning of patients with orbital floor fractures.

BACKGROUND: Ocular motility impairment associated with orbital trauma may have several causes and manifest with various clinical symptoms. In some cases orbital reconstructive surgery can be very challenging and the results are often unsatisfactory. The use of modern imaging techniques aids proper diagnosis and surgical planning. CASE REPORT: The authors present the case of a 29-year-old male who sustained trauma to the left orbit. Orthoptic examination revealed limited supra- and infraduction of the left eye. The patient reported diplopia in upgaze and downgaze with primary position spared. Dynamic magnetic resonance imaging (dMRI) was performed, which revealed restriction of the left inferior rectus muscle in its central section. A patient-specific anatomical model was prepared on the basis of 3-dimensional computed tomography (CT) study of the intact orbit, which was used to prepare a custom pre-bent titanium mesh implant. The patient underwent reconstructive surgery of the orbital floor. CONCLUSIONS: Modern imaging techniques such as dMRI and 3-dimensional CT reconstruction allow us to better understand the pathophysiology of orbital floor fractures and to precisely plan surgical treatment.

The use of dynamic magnetic resonance in the diagnosis of ocular motility disorders.

UNLABELLED: Dynamic Magnetic Resonance (dMRI) of the extraocular muscles is based on performing a number of short sequences, while the patient fixates consecutive points placed in different positions of gaze. PURPOSE: To check the relation between dMRI findings and the results of clinical examination in patients with various types of strabismus. MATERIALS AND METHODS: We have selected three patients with lateral rectus palsy, superior rectus palsy and inferior rectus restriction from the group, in which we have performed dMRI. We have taken measures of the affected muscles shape, sectional area and volume. The results were related with the clinical examination. RESULTS: The measurements obtained with use of dMRI reflect the actual state of the affected muscle as seen on the Hess screen. The limitation of the muscles action is represented by a lack of increase in the sectional area and volume in respective gaze intervals. The restriction of the muscle affects its shape by pulling it towards the place of entrapment. CONCLUSIONS: Data acquired by means of dMRI correspond to the clinical findings and allow a quantitative analysis of the degree of muscle weakness. Defining the extent of the morphological changes in extraocular muscles, related with long-lasting paralysis, let us make an informed decision regarding further treatment.

Treatment with individual orbital wall implants in humans - 1-Year ophthalmologic evaluation.

BACKGROUND: In 2009 a method of creating individual, patient specific orbital wall implants using rapid prototyping (RP) was shown in a preliminary human study. That study showed that it is financially viable to produce anatomical models and that this technology could be used in the repair of orbital floor fractures. MATERIALS AND METHODS: In this study, 24 consecutive subjects who had sustained orbital fractures (14 males, 6 females) without any coexisting central nervous system or globe injury were assessed post-operatively. The first series of 12 patients, recruited during the period 2005-2006, were treated with classical method (CM) of forming titanium mesh by manual manipulation, based on individual subjective assessment of the extent and shape of damaged orbital walls. The following 12 cases, recruited between 2007 and 2008, were treated with patient specific titanium mesh implants designed with an RP method. Early (2 weeks) and late (12 months) follow-up was performed. Patients were evaluated by binocular single vision (BSV) test and an assessment of eye globe motility. RESULTS: The superiority of the RP treatment method over CM was shown on the basis of early results when BSV loss area and reduction of vertical visual disparity (VVD) in upgaze were considered. Better outcomes for the RP group were confirmed in the late follow-up results which showed a reduction of BSV loss area, correction of primary globe position and a very significant improvement in upgaze. CONCLUSIONS: One-year post-operatively, functional assessment of pre-bent individual implants of the orbital wall has shown the technique to be a predictable reconstruction method. Nevertheless longer follow-up and an increase in the number of cases treated are required for the full evaluation of the technique.

The efficacy of vertical rectus transposition and its modalities in patients with abducens nerve palsy.

PURPOSE: Patients with VIth nerve palsy that does not resolve within 6 months should undergo surgery. The most common procedure used in such cases is transposition of a whole or a part of a vertical rectus muscle combined or not with a resection of the lateral rectus muscle. Commonly, a simultaneous recession of medial rectus muscle with or without prior injection of botulinum toxin is performed. The aim of our study was to evaluate the results of vertical rectus transposition performed in patients with abducens nerve palsy. METHODS: Nine cases of abducens nerve palsy ware retrospectively analyzed. All patients underwent full ophthalmic and orthoptic examination before and after surgery. All patients underwent vertical rectus muscle transposition to the lateral rectus insertion in the affected eye. Additional procedures included Jensen procedure, botulinum toxin injection, resection of the lateral rectus, recession of the medial rectus on the same side with or without adjustable sutures, and Foster modification of lateral rectus posterior fixation. RESULTS: In all cases, we found a varying degree of postoperative improvement. There was a significant reduction in the strabismus angle for distance and near, increase in abduction of the affected eye, and broadening of the field of binocular single vision. CONCLUSIONS: The vertical rectus muscle transposition technique is a safe and successful method of treatment in abducens nerve palsy. Its use together with additional procedures and modifications allows one to achieve orthophoria, improvement of abduction, and larger field of binocular single vision.

[Refractive laser eye surgery and binocular vision disorders--case report]. / Laserowa korekcja wady refrakcji a zaburzenia widzenia obuocznego--opis przypadku.

UNLABELLED: Laser refractive surgery is a lively developing branch of ophthalmology. There are a numbers of contraindications for this type of surgery, but many of them are difficult to define, for example binocular vision impairment. Accurate analysis of orthoptic examination before refractive surgery, has forced us to dissuade our patient from refractive surgery, despite the fact that there were no other contraindications. CASE STUDY: A 33 years old woman referred for refractive surgery because of bilateral myopia (right eye: -5.25 Dsph -0.75 Dcyl ax. 170; left eye: -5.0 Dsph). There was no strabismus or other binocular vision disorders in her history. Orthoptic examination revealed exophoria, slight hyperphoria and considerable bilateral convergence insufficiency, which would have contributed to future strabismic complications.

[In what age should we operate on children with primary exotropia? Indications based on own therapeutic results]. / Jaki wiek powinny osiagnac dzieci z pierwotnym zezem rozbieznym, aby mozna bylo efektywnie je operowac? Wskazania na podstawie wlasnych wyników leczenia.

PURPOSE: The aim of the study was to evaluate the results of surgical treatment of children with primary exotropia, operated on before 14 years of age. MATERIAL AND METHODS: The study included 62 children with primary, constant and intermittent exotropia operated on before 14 years of age. The patients were divided into two age groups. The first one consisted of children 2 to 6 years old (mean 4.75 +/- 1.12)--12 girls and 8 boys, the second group consisted of children 7 to 14 years old (mean 9.3 +/- 2.1)--30 girls and 12 boys. Follow-up period was 3.5 years in group I and 4.5 years in group II. History, visual acuity and refraction were obtained in all cases. Horizontal and vertical angles for distance and near, before and after the surgery was measured as well. The postoperative horizontal angle drift was estimated in both groups and function of binocular vision assessed, before and after the surgery. RESULTS: In both age groups we found no statistical difference between mean angle values before and few weeks after the surgery. However in long-term results, angle for distance was lower in younger children, especially in those with intermittent strabismus. The postoperative angle drift was lower in younger group with intermittent strabismus comparing to the older group, so they achieved a better final surgical outcome. The functional results in both age groups did not differ significantly. CONCLUSIONS: Early surgery on divergent strabismus makes the prognosis better, especially in intermittent strabismus. Children that are operated on early, seem to have smaller postoperative angle drift.

Clinical application of 3D pre-bent titanium implants for orbital floor fractures.

INTRODUCTION: Orbital structures are affected in approximately 40% of all cases of craniofacial trauma. Changes in the bony orbital dimensions can alter the function of intraorbital contents and lead to serious complications. The unique anatomy of the orbit and the resulting surgical approaches make the process of fitting and aligning implants difficult, time consuming and operator dependent. It is now possible to make relatively inexpensive anatomical models on the basis of computed tomography images, using rapid prototyping. Such models can be used as templates to form titanium mesh implants, which are then used in the reconstruction of orbital floor defects. MATERIAL AND METHODS: Six patients with facial trauma were included in this study. First, 3D virtual models and then physical models were created. These were used as templates to shape the titanium mesh and then intraoperatively as guides to aid correct implant placement in the orbit. RESULTS: Significant improvement resulted in three cases and total recovery in three cases. CONCLUSION: It is financially viable to build anatomical models, on the basis of CT studies, that can be used in the repair of orbital floor fractures.