Janet C. Weber

Surgical Treatment of Congenital Esotropia

We conducted a retrospective study of 133 children (69 boys and 64 girls) who underwent bilateral medial rectus muscle recession (most by the augmented or en-bloc technique) for congenital esotropia. Esotropia was diagnosed before the age of 6 months in 84 patients and after the age of 6 months in the other 49. A total of 27 children underwent surgery before the age of 12 months; of these, three required second procedures. A total of 106 children underwent surgery after the age of 12 months; of these, eight required second procedures. The mean preoperative deviation was 40 prism diopters. Two patients had significant A pattern deviations and 17 had significant V pattern deviations. Six patients had dissociated vertical deviations. Five to 60 days after surgery, 52 patients had no deviation and 99 were within +/- 10 prism diopters of no deviation. Two months after surgery, 67 patients had no deviation and 114 were within +/- 10 prism diopters of no deviation. Final alignments (five months to seven years postoperatively) showed that 51 patients had no deviation and 109 were within +/- 10 prism diopters of no deviation. Despite adequate alignment, none of 13 patients whose esotropia was diagnosed before the age of 6 months, who underwent surgery before the age of 12 months, and who cooperated with testing achieved stereopsis. This suggested that there may be two types of congenital esotropia--one without fusion potential and one in which fusion is possible but lost secondarily because of peripheral esotropic factors.

Augmented Recession of the Medial Recti

Bimedial rectus recession with measurement from the limbus was combined with conjuctival recession 85 children undergoing surgery for esotropia. Using this augmented recession technique, the prism diopters of correction per millimeter of surgery done were 4.8 compared with 3.2 found in 56 control patients. Postoperatively, the conjunctiva had a satisfactory cosmetic appearance and ductions were normal.

A comparison of the intraocular reactions of rabbits to yeast-phase and mycelial-phase histoplasmin*

Rabbits given intravitreal or suprachoroidal injections of yeast-phase or mycelial-phase histoplasmin developed endophthalmitis. The degree of this reaction could be influenced by intradermal injection of the antigen prior to intrabulbar injection. Intradermal injection of yeast-phase histoplasmin enhanced the endophthalmitis, whereas injection of mycelial-phase histoplasmin depressed it.