John P. Burke

Psychosocial implications of strabismus surgery in adults.

PURPOSE Adults with socially noticeable strabismus have been known to experience psychosocial difficulties as a result of their abnormal eye position. This study was designed to assess the impact of noticeable strabismus in adults and the psychosocial effects of surgical correction. METHODS A total of 31 adults who underwent surgery for longstanding horizontal strabismus where poor alignment was the primary reason for consenting to surgery were requested to complete a self-reporting repertory grid to appraise the psychosocial consequences of corrective strabismus surgery. RESULTS Prior to corrective surgery, the majority of subjects reported various psychosocial difficulties, considered by them to be wholly or partly due to their unsightly strabismus. A significant improvement in interpersonal interactions is apparent following strabismus surgery. CONCLUSION Surgery to improve ocular alignment appears to herald major improvements in the quality of psychosocial functioning for the majority of adults undergoing such surgical procedures (P < 0.001).

Whiplash and its effect on the visual system

Whiplash or indirect injuries to the neck as a consequence of motor vehicle collisions are a common occurrence in which the frequency of ocular complications is largely unknown. Ophthalmic and oculomotor function was investigated in a longitudinal study of 39 cases who had their initial ophthalmological assessment within one week of the whiplash injury. Ten of 39 cases had ocular symptoms and signs which developed shortly after the accident. The principal abnormality in 6 of these was decreased convergence and accommodation, superior oblique muscle paresis in 2, decreased stereoacuity in 1 and bilateral vitreous detachments in 1 patient. All but 2 had complete resolution of their symptoms within 9 months. Four other patients were asymptomatic but had ophthalmic signs which resolved within 3 months. Oculomotor abnormalities following whiplash injuries are generally mild, have a good prognosis, and would appear from this study to be commoner than hitherto expected.

Diode laser photocoagulation to the vascular retina for progressively advancing retinopathy of prematurity.

AIMS--To estimate the effectiveness of diode laser photocoagulation of the retina posterior to the ridge in eyes with retinopathy of prematurity (ROP). METHODS--Diode laser photocoagulation was applied posterior to the fibrovascular ridge in stage 4a ROP in six eyes of four infants and in advancing stage 3+ in two eyes of one infant. Seven eyes had previously been unsuccessfully treated with diode laser photocoagulation anterior to the ridge. RESULTS--Six eyes of four children had total regression, two eyes of two children had flat maculae with residual peripheral tractional detachment and maintained vision. CONCLUSION--These preliminary results indicate that diode laser photocoagulation posterior to the ridge may be a useful treatment in late stage 3 and stage 4A ROP following failed laser treatment to the avascular retina in threshold stage 3 disease.

Convergence excess esotropia treated surgically with fadenoperation and medical rectus muscle recessions.

Convergence excess esotropia has been treated with bifocals, miotics, medial rectus recession(s), fadenoperation, or a combination of these. However, comparatively few studies on the sensory status of these patients exist. We present the sensory findings in 31 children treated surgically. Twenty-one had fadenoperations combined with bimedial rectus recessions, one had a fadenoperation alone, and nine had augmented bimedial rectus recessions. Five children (16%) achieved bifoveal fusion, 22 (71%) had varying degrees of peripheral fusion, and four (13%) had no detectable binocularity after a mean postoperative follow-up of 2.4 years.

Orbital blowout fractures — the influence of age on surgical outcome

Abstract We report the frequency of troublesome diplopia in 17 patients (11 patients ≤ 21 years) who underwent surgical repair of traumatic orbital blowout fractures. Thirteen patients had primary surgery performed within 21 days of injury, 2 patients at 4 and 6 weeks and 2 cases at 6 and 24 months. The latter continues to complain of diplopia. Contrary to previous studies, we found that young patients were no more likely to suffer from symptomatic post‐operative residual diplopia than their adult counterparts.

Recurrent corneal epithelial erosions in Alport's syndrome

Abstract Alports syndrome is a heritable disorder of uncertain aetiology characterized by nephritis, sensori‐neural deafness and ocular abnormalities. Bilateral corneal epithelial erosions are a previously unreported finding which support the hypothesis that Alports syndrome is a disorder of selected basement membranes.

Effectiveness of inferior transposition of the horizontal rectus muscles for acquired inferior rectus paresis.

Full inferior transposition of the horizontal recti (inverse Knapp procedure) was performed on four patients with unilateral inferior rectus muscle weakness. The patients were followed up over time to determine the medium- and long-term effectiveness of the procedure. All of the patients had single binocular vision without the use of prisms in the primary position of gaze and three in the reading position after a mean postoperative follow-up interval of 21/2 years. The mean primary position preoperative vertical deviation was 20.3 delta and the mean primary position postoperative vertical correction was 19.5 (range, 16 to 24) delta. The field of binocular single vision was assessed quantitatively and scored 2.4% preoperatively compared with 52.3% postoperatively. There was no decrease in the effect of the procedure over time. Additional surgery may still be required to correct symptomatic residual vertical down-gaze diplopia.

Choroidal neurofibromatosis with congenital iris ectropion and buphthalmos: relationship and significance

We report a case of unilateral buphthalmos in neurofibromatosis-1 without the other classical characteristics of the François syndrome (triad of unilateral buphthalmos, homolateral eyelid plexiform neuroma, and homolateral facial hemihypertrophy) and emphasize the difficulties in early diagnosis. The painful buphthalmic right eye was enucleated at the age of 13 months. Histopathology demonstrated diffuse choroidal neurofibromatosis in association with congenital iris ectropion syndrome. Cutaneous manifestations of neurofibromatosis subsequently developed in the patient and stigmata of the disease were later identified in other asymptomatic family members.

Convergence Insufficiency in Thyroid Eye Disease

The incidence of convergence insufficiency in patients with thyroid ophthalmopathy and their response to convergence exercise is unknown. Twenty-seven consecutive patients with thyroid eye disease (TED) were evaluated prospectively. Six patients with symptomatic convergence insufficiency obtained varying degrees of subjective and objective benefit from treatment. None of the six had other TED-related complaints that required therapeutic intervention. The study findings should alert the clinician to consider convergence insufficiency in patients with TED and nonspecific ophthalmic symptoms.

Carbamazepine, epilepsy, and optic nerve hypoplasia.

The 4th edition of this book, first published almost 30 years ago, is dedicated to the memory of the late senior editor described as the motivator of this lexicographic work. The majority ofthe 68 contributors are optometrists or basic scientists, with a mere handful of clinicians. Not surprisingly, there is a certain bias towards optometric terminology, and indeed the strength ofthe book lies in its coverage of physical and geometrical optics, ophthalmic dispensing, and vision therapy. As stated in the preface, this edition extends the coverage of ocular genetics, pharmacology, familiar and unfamiliar acronyms, and abbreviations and syndromes with ocular manifestations. On the whole the clinical listings are rather disappointing and somewhat limited, with inclusion of many obsolete terms and nomenclature. As intended, the definitions are generally succinct, and a phonetic respelling follows most entries. There are very few listings accompanied by their derivation, which is somewhat disappointing. Throughout the text there is a random selection of line diagrams depicting mostly optical principles and equipment with photographs of clinical disorders, many of which are of poor quality. Clinical terms can prove difficult to find, and eponymous titles are listed under disease, syndrome, or anatomical structure. There is a wealth of archaic clinical terms which offer a certain fascination and would be guaranteed to floor or possibly demolish an unsuspecting examination candidate. There is a brief appendix including ophthalmic clinical abbreviations, symbols, and useful optometric data. Although the dictionary has a number of shortcomings, it will nonetheless prove a useful reference manual for all workers in the field of visual science. ROBERT J COOLING