Preliminary report: analgesia with Remifentanil for complicated eye muscle surgery.

The authors report a new anesthetic technique that is especially suitable for the surgery of complicated disorders of ocular motility. Analgesia is achieved by an intravenous dose of Remifentanil, an opioid that is normally used together with propophol as a form of total intravenous anesthesia (TIVA) for general anesthesia. The advantage of Remifentanil is a rapid increase (1-2 min.) and decrease (3-4 min.) of the effect. Eye muscle surgery can then be performed on a patient who is free of pain and slightly sedated. After the planned eye muscle surgery, while the patient is still under anesthesia, the muscle sutures are tied provisionally. Afterwards, the squint angle can be measured with a cover test and the patient is questioned about the presence of diplopia. If the position of the eye is not satisfactory, the knots can be loosened and the muscle can be fixated in another position.

Multihandicapped blind and partially sighted children in south Germany. I: Prevalence, impairments and ophthalmological findings.

Data on prevalence, impairments, neuropaediatric and ophthalmologic findings are reported in a population-based study of 239 multihandicapped blind and partially sighted children in South Germany born between 1981 and 1987. With a prevalence of 0.67 per 1000 live births this type of impairment was rare. However, most children in this series were very severely impaired with very low developmental age and several additional impairments. Most children had lesions of the visual pathways without significant involvement of the eyes. Ophthalmological and neuroradiological findings indicated that optic nerve atrophy and lesions of the posterior visual pathways frequently coexisted.

[Development of impaired vision in mentally handicapped children]. / Entwicklung der Sehbehinderung von geistig behinderten Kindern.

The aim of the following study was 1) to show the incidence of ophthalmic disorders in severely visually and mentally handicapped children retrospectively 2) to follow up the change in visual acuity over at least 2 years prospectively 3) to look at the effect of therapeutic concepts. 270 children of the "Blindeninstituts-stiftung Würzburg" were followed up between 1960 and 1987. ad 1) Optic atrophy was the leading cause of visual impairment (24%) followed by cataract and retinopathy of prematurity (both found in 17%), malformations of the anterior segment (12%), cortical amblyopia (8%) and refractive error (6%). Strabismus was an additional finding in 38% of the children often associated with nystagmus. Convergent and divergent strabismus had the same incidence. ad 2) Visual acuity improved in 30% of cases of cortical amblyopia, in 40% of refractive errors and in 30% of optic atrophy. In cases of cataract there was a slight improvement in 20%. In 24% of aphakia a secondary glaucoma was observed. In cases of malformations of the anterior segment and ROP the visual acuity remained stable on a low level. The cases of ROP were advanced and had not received any surgical treatment. A deterioration in vision as often seen after surgical intervention was observed in 20% of ROP. In respect of the high incidence of refractive errors and orthoptic problems in multiple handicapped children they should be seen as early as possible by an ophthalmologist. Detection of a congenital cataract soon after birth as well as complications of other disorders should help to prevent blindness. The remaining visual perception is especially important for the handicapped child to communicate and move about.

Attachment to mother/attachment to father: a meta-analysis.

An important tenet of attachment theory is that classification of security or insecurity as derived from the Strange Situation reflects the quality of an infant's relationship with its caregiver. One piece of evidence supporting this claim is the lack of concordance of classification between an infant and its mother and father. We performed a meta-analysis of the 11 studies that have examined the concordance of mother/father attachment to an infant. We found that security of attachment to one parent was dependent upon security to the other parent, that type of insecurity (avoidant/resistant) to one parent was dependent upon type of insecurity to the other, and that subcategory classification within the secure category (B1B2/B3B4) to one parent was dependent upon subcategory classification to the other. These data raise important questions regarding the meaning of infant attachment classification as derived from the Strange Situation. Among the possible explanations for the pattern of data are existence of concordant parenting styles and/or influence of infant temperament (possibly the tendency to cry upon separation) on classification of security/insecurity in the Strange Situation.

[Side differences in the position of the corneal apex in relation to the lateral orbital margin (measurements with the Hertel exophthalmometer)]. / Uber Seitenunterschiede der Lage des Hornhautscheitelpunktes zum lateralen Orbitarand (Messungen mit dem Exophthalmometer nach Hertel).

Proptosis was measured with Hertel's apparatus in 430 persons ranging in age from 3 to over 60 years. They were divided into 12 age groups for males and 12 for females. Measurements were performed independently by two investigators. The average of all readings shows the left eye in males 0.49 mm in front of the right eye. In females the difference is 0.52 mm (males: right eye 15.25 mm, left eye 15.74 mm; females: r.e. 14.79 mm, l.e. 15.31 mm). From the third to the 20th year of life there is a permanent increase in proptosis from about 13.0 to about 16.7 mm. There are no major differences between males and females. After the 20th year, males show a small increase up to 17.0 mm. In females the readings drop to about 15.6 mm. Lefthandedness in young people is found in 13.6% of males and in 5.7% of females.

[Case report of a gonoblennorrhoea in both eyes (author's transl)]. / Bericht über eine beidseitige Gonoblennorrhoe.

It is reported of a serious form of a gonoblennorrhoea in both eyes of a five-week old girl. The baby had the typical symptoms of this disease. An intense local and general therapy with Penicillin G was applied and the infection ceased within two weeks after reception. The reason of the infection was a transfer from hand to eye, because her mother suffered from a gonorrhoeal urethritis.

[Low-vision aids in visually handicapped children (author's transl)]. / Verordnung von Sehhilfen bei sehbehinderten Kindern

It is reported on 71 visually handicapped pupils. The visual acuity of 48 of these children could be tested with low-vision aids and the electronic television reading apparatus (Reinecker). With telescopic glasses (Zeiss, Keeler) 31 children had an average improvement of their visual acuity of two lines on a test board for near vision (Birkhäuser). With the reading apparatus 43 children showed an improvement of the visual acuity of 5 more lines. Only 3 to 21 pupils, who had been offered a regular use of the telescopic glasses, decided to have one. Finally our own experiences are compared with those of other authors.

[Observations on long term medication with atropine eye-drops (author's transl)]. / Beobachtungen nach Atropin-Langzeitverordnung

It is reported on two children which had moderate general symptoms after long term application of atropine eye-drops. This was observed the day after discontinuing this medication. The symptoms of nausea, vomiting and perspiration were similar in both children and disappeared after one day. The reason for the symptoms is discussed and it is warned against an excessive application of atropine eye-drops.

[A contribution for recording data in strabismus (author's transl)]. / Ein Beitrag zur Erfassung strabologischer Befunde

The recording of the data of all investigations in strabismus concomitans convergens is done by a formular, which is presented in this paper (Fig. 1). The data code is printed on the backside (Fig. 2). It is possible to evaluate the results with this formular in a computer by punch cards. A quick information without computer help is possible as well. The methods of recording data used by different authors are explained and the advantages and disadvantages are discussed.

[Results of surgical treatment in strabismus convergens (author's transl)]. / Untersuchungen zur Operationsdosierung bei Strabismus convergens

In 252 patients with strabismus concomitans convergens the surgical method of the combined medial rectus recession and lateral rectus resection (Fig. 1) was studied retrospectively. The reduction of the deviation was compared with the added displacement of both muscles (Figs. 2 and 3) or the displacement of one single muscles (Table 1 and 2). Fig. 4 shows the relation between the recession-resection and the reduction of the deviation. A formula for this reduction (Z) is given: Z=6.7 chi recession (in mm) + 2.2 chi resection (in mm) - 8.1. In long the recession is 3 times more effective than the resection. In 61.5% of the patients the eyes stood parallel after surgery or a residual deviation up to 5 degrees was achieved. There was a little difference in the total results of the first (1 week) and the second (6 months) postoperative control. Major differences occurred when comparing single data.