Hypertropia following trochlear trauma.

Hypertropia following trauma to the trochlea is rare. The more widely recognized response of the trochlea to trauma is hypotropia or acquired Brown syndrome. We observed three cases of hypertropia following penetrating trauma to the trochlea. Each had computerized tomography and/or magnetic resonance imaging to assist in the understanding of the mechanism of the observed superior oblique dysfunction. The clinical course of these cases was variable. Awareness of the damaged trochlea's capacity to respond as a hypertropic as well as a hypotropic syndrome will allow for improved management of these unusual patients.

[Severed musculus rectus internus caused by a dog bite]. / Abgetrennter Musculus rectus internus verursacht durch einen Hundebiss.

A four-year-old girl sustained facial injuries from multiple dog bites. Although the globe exhibited slight adduction saccades the medial rectus muscle appeared to be intact when examined by computer tomography. However, on surgical exploration of the orbit the muscle parenchyma was found to have been completely severed.

Autosomal dominant congenital cataract associated with chromosomal translocation [t(3;4)(p26.2;p15)].

We studied a family in which congenital cataracts were found in a father and son who had a reciprocal translocation between the short arms of chromosomes 3 and 4 [t(3;4)(p26.2;p15)]. The father's parents and brother had normal chromosomes and no evidence of cataracts. While results of these studies do not prove a causal relationship, they do strongly suggest that the areas near the break points involved in the translocation (3p26.2 and 4p15) would be good sites for further investigations into the genetic basis of this type of cataract.

Pars plana management of ectopia lentis in children.

Although the removal of the lens from patients with ectopia lentis has long been associated with a high rate of surgical complications, the surgical outlook for these patients is improving now that more sophisticated surgical modalities are available. We treated a series of eight consecutive patients with pars plana lensectomy (12 eyes) whose visual acuity could not be satisfactorily improved with optimal optical correction (phakic or aphakic). Visual acuity could not be improved in any of the subjects. Preoperative visual acuities ranged from 5/400 to 20/70. Eleven of 12 eyes maintained a visual acuity of 20/40 or better postoperatively over follow-up periods ranging from 1.0 to 6.3 years (mean, 5.1 years). There have been no significant surgical complications.

Superior oblique tenotomy in the treatment of isolated inferior oblique paresis.

Both tenotomy and tenectomy of the homolateral superior oblique muscle have been advocated as surgical treatment for isolated paresis of the inferior oblique muscle. An iatrogenic superior oblique palsy has been reported to be a frequent complication of superior oblique tenectomy. This complication appears to be less frequent following superior oblique tenotomy. Of 16 consecutive patients with isolated inferior oblique paresis treated by homolateral superior oblique tenotomy and followed an average of 5.0 years (range six months to 11.6 years), only two patients demonstrated a superior oblique palsy postoperatively. Large vertical deviations with spread of comitance, however, required a superior rectus recession of the fellow eye in addition to superior oblique tenotomy.

The neglect of Purkinje's technique of ophthalmoscopy prior to Helmholtz's invention of the ophthalmoscope.

A technique for examining the fundus of the eye was devised by Jan Evangelista Purkinje a generation before Helmholtz invented the ophthalmoscope. Yet, Purkinje's technique of ophthalmoscopy went virtually unnoticed by his contemporaries. This neglect of Purkinje's discovery has never been fully explained and warrants re-examination.

Surgery for large-angle congenital esotropia. Two vs three and four horizontal muscles.

Large-angle congenital esotropia is usually managed surgically by either of two fundamentally different approaches: (1) the uniform approach, in which surgery is restricted to two extraocular muscles (bimedial recessions or monocular recession-resection), or (2) the selective approach, in which bimedial recessions are combined with resections of one or both lateral rectus muscles. We compared surgical results of the two types of surgery during a ten-year period for 107 patients, of whom 57 underwent bimedial recessions, two had monocular recession-resections, and 48 received three- or four-muscle surgery. The average follow-up time was 2.6 years. The percentage of good surgical results (orthophoria +/- 10 PD) in the selective group was 64.5%, compared with 37.3% in the uniform group. Only three of the 48 patients in the selective group required a second procedure, compared with 17 of 59 patients in the uniform group.

Canalicular cystocele.

We report a rare case of acquired canalicular cystocele in a patient with obstructions at both the proximal and distal ends of the inferior canaliculus. Histopathologic examination revealed a dilated tubule lined with nonkeratinizing squamous epithelium that measured 19 mm long and 7 mm wide. No mucous secreting goblet cells were observed in any sections. The fibrotic, thickened wall was infiltrated with epithelioid, lymphoid, and occasional plasma cells.