[Surgical treatment of accommodative convergence access esotropia. Study of 50 operated cases]. / Traitement chirurgical de l'excès de convergence accommodative. Etude de 50 cas opérés.

BACKGROUND: Convergence excess esotropia (EC) can be an additional component in all forms of strabismus. The most favourable prognosis is found in those cases where EC is associated with microtropia or bifoveal fusion, due to a better binocular potential. METHODS: 50 non selected cases were entered into the study and divided into two groups (Group A: EC with microtropia; Group B: EC with bifoveal fusion). All the patients were followed at the Lausanne Strabismus Unit and all cases underwent a bilateral medial rectus posterior fixation (Cüppers' Faden operation) placed at 13 mm from the original insertion. RESULTS: In Group A, the average reduction of angle of strabismus was 25 delta for near fixation, 20 delta in Group B. In both groups, the average decrease in angle for distance fixation was 6 delta. In Group A, 75% of cases gained some binocularity post-operatively, not only for distance but also for near fixation. In Group B, all the patients showed a normal response on the Lang stereotest post-operatively. CONCLUSIONS: In both groups of this study, a bilateral medial rectus retroequatorial myopexy was a satisfactory alternative for those patients who refused to wear bifocal glasses.

[Inclination of the Hess-Weiss coordimetric graph. An indirect sign of ocular torsion?]. / L'inclinaison du schéma coordimétrique de Hess-Weiss en forme libre. Un signe indirect de torsion oculaire?

BACKGROUND: The coordimetric examinations according to Hess-Weiss (HW) and Hess-Lancaster produce the bidimensional graphic demonstration of eye deviations. The horizontal and vertical deviations can be shown easily, whereas cyclotorsion cannot be detected readily. Clinical experience has suggested, however, that there may be an association between rotation of the HW graph and cyclotorsion. The question is, how much can the bidimensional presentation be influenced by the cyclotorsion? METHODS: 48 patients with posttraumatic superior oblique palsy were investigated. The cyclotropia measured at the tangent scale of Harms (dark-red glass method) was compared to the rotation of the HW graph. Patients were divided into 2 groups: 27 unilateral and 21 bilateral palsy. CONCLUSION: The association between the two examination parameters was significant in both patient groups (Group 1 p < 0.01, Group 2 p < 0.05).

[Partly accommodative convergent strabismus with and without excess convergence. Surgical treatment]. / Strabisme convergent accommodatif partiel avec et sans excès de convergence. Traitement chirurgical.

BACKGROUND: Partly accommodative esotropia typically shows a persistent convergent angle after correction of hypermetropia. This condition can-or cannot-be accompanied by an accommodative convergence excess. PATIENTS AND METHODS: Fifty patients were examined, operated on and followed up by the same team, and were separated into 2 groups: Group 1: partly accommodative esotropia without convergence excess (N = 20); Group 2: partly accommodative esotropia with convergence excess (N = 30). The operations of the first group consisted of 11 posterior fixations (Fadenoperations) on both internal recti (IR), and 9 combined horizontal operations or recessions of both IR. The operations of group 2 consisted of 23 Fadenoperations and 7 classic procedures. RESULTS: Comparison of angle reductions after a 6-month follow-up showed that posterior fixation was more effective in reducing esotropia when measured without glasses (p = 0.003), whereas both techniques produced similar effects when angles were considered with correction of hypermetropia. In group 2, the effects of posterior fixation on residual angles at near were significantly higher than on angles measured at distance fixation (p < 0.001). Objective refraction (median) was S + 3.60 for group 1 and S + 1.75 for group 2. CONCLUSION: Fadenoperation appeared to satisfactorily reduce convergence excess in our group of 30 patients with partly accommodative esotropia. In our series of 20 patients with accommodative strabismus without convergence excess, Fadenoperation was more effective only when angles were considered without glasses.

[Stilling-Duane retraction syndrome; surgical options]. / Le syndrome de rétraction de Stilling-Duane; options chirurgicales.

BACKGROUND: The Stilling-Duane's retraction syndrome is a congenital abnormality of ocular movements. In order to maintain simple binocular vision, most patients adopt an abnormal head posture; this can be corrected by surgery. MATERIALS AND METHODS: We carried out a retrospective study of the clinical files of 56 patients who presented with Duane's syndrome and had been examined at the Strabological Department of the Lausanne Eye Clinic between 1974 and 1993. RESULTS: Our group study is comparable to that found in the literature as regards the distribution according to sex (45% of males, 55% of females), laterality (75% of the cases with disease predominance in the left eye, 18% in the right eye, and 7% with bilateral, symmetrical disease), and associated anisometropia (18%) or amblyopia (12.5%). Approximately 1 of 5 patients sought medical advice only after 20 years of age. A compensating head turn (towards the ill side in patients with esotropia and towards the healthy side in patients with exotropia) was found in 71% of the cases. Our surgery (10 patients with a mean follow-up of 8 months) resulted in a decreased head turn in 7 cases. CONCLUSIONS: The purpose of this surgery is to improve the head turn without worsening retraction. This can be achieved with simple muscle recessions.

[A new software for handling surgical data in strabology]. / Un nouveau logiciel de gestion des données chirurgicales en strabologie.

BACKGROUND: Numerous measurements and data are the hallmark of strabismology. Handling these data is greatly facilitated by the use of computers. An adequate software should also allow surgical results analysis and quality control. Standardisation of data is mandatory. METHODOLOGY: We developed such an application based on a commercially available database (4th Dimension, ACI Paris). It uses 5 relational files. RESULTS: This software is userfriendly and can be used by anyone. No special code is necessary to enter data and these values are automatically verified. Patient's data, diagnosis, type of surgery and angle measurements (pre- and post surgery) can be entered, usually by an orthoptist, right after examination. CONCLUSION: Numerisation of strabologic surgical data can be easily realised with the help of a programmable database, but rigorous terminology is mandatory. Indeed the use of a strict terminology is helpful in teaching hospitals.