Associated incomitance in concomitant strabismus. Diagnosis and surgical treatment.

BACKGROUND: The motor deviation in concomitant strabismus may be accompanied by horizontal, vertical and/or torsional incomitance that hinders the development of binocularity. This should be corrected together with the horizontal deviation or in a repeat surgery. PATIENTS AND METHODS: A series of seventeen patients suffering from a major form of incomitance A or V pattern eso- or exotropia was investigated clinically. Incomitance was measured in all directions of gaze, horizontally, vertically and, as far as possible, torsionally. In 8 cases magnetic resonance tomography of the orbits was performed and has shown in particular,the position of the insertion of the lateral recti, relative to that of the medial recti. All the patients underwent surgery. Clinical, radiological and intra-operative data were concordant in all cases. RESULTS: All possible clinical forms or any combination thereof could be defined with precision and corrected according to the motor disorder of each case. After surgery the A or V pattern was reduced to 4° or less in all cases. The vertical deviation was corrected at least between 25° right and left gaze in all cases but 3. DISCUSSION: The most appropriate surgical strategy for the individual clinical form can be determined. The"triple procedure"includes the shift to the horizontal meridian of the insertion combined/or not with a slanted recession or plication of the lateral rectus, and the recession of the overacting oblique muscles. It enables us to correct in a single surgery both horizontal and cyclo-vertical incomitance. CONCLUSION: The correction of associated incomitance significantly improves motor and angle dependent sensory results in the management of concomitant strabismus.

Reduced number of hemidesmosomes in the corneal epithelium of diabetics with proliferative vitreoretinopathy.

Morphometry on transmission electron micrographs of the hemidesmosomal width was related to the length of the basal plasmalemma in corneal epithelium biopsy specimens. The basal plasmalemma length occupied by hemidesmosomes showed a mean fraction of 0.227 in eight patients undergoing cataract extraction or vitrectomy for diabetic proliferative vitreoretinopathy. In seven non-diabetic control patients of comparable age and sex undergoing cataract or pterygium surgery, 0.412 of the basal plasmalemma was covered by hemidesmosomes. A reduction in hemidesmosomes (P less than 0.001) may contribute to a weakness in the adhesion of diabetic corneal epithelium to the underlying stroma.

[Retrobulbar corticotherapy]. / La corticothérapie par voie rétro-bulbaire.

Corticotherapy has been proposed several times for the treatment of venous thrombosis of the retina (e.g., Hayreh 1975). Since 1975 the present authors have used it regularly, combined with heparinotherapy, for all types of retinal vascular occlusion, in the form of retrobulbar injections of corticoids. The aim is to reduce edema of the vascular wall at the occlusion and re-establish or improve the flow, and thereby protect the sensory cells during the critical repair period. In edematous or mixed types of venous thrombosis, the effectiveness of the treatment is demonstrated by a rapid improvement in acuity. As recommended by Hayreh, corticotherapy is certainly indicated for edematous and mixed thromboses with loss of central field acuity. In other types of vascular occlusions (ischemic venous thrombosis, arterial occlusion, and vascular papillitis) the benefit can only be guessed at. Corticotherapy is not a replacement for anticoagulation, laser coagulation, or general treatment.