Patrick A. DeRespinis

Duane's retraction syndrome☆

Duanes retraction syndrome (DRS) has been a recognized clinical entity for nearly a century. It is a clinically well described ocular disorder consisting of retraction of the globe with narrowing of the lid fissure in attempted adduction, frequent abduction deficiency with variable limitation to adduction, and upshoot and/or downshoot of the affected eye on adduction. Among strabismus patients the incidence of DRS is probably not more than 5%. Most cases are sporadic, but familial cases have been estimated at 10% by most authors. Numerous theories concerning the etiology and pathogenesis of DRS have been proposed, including agenesis of the abducens nucleus, but the majority of investigators concur that the characteristic findings are best explained by a paradoxical innervation of the lateral rectus muscle, which subsequently causes a cocontraction of the horizontal rectus muscles. The frequent association of DRS with other congenital anomalies suggests a teratogenic event occurring between the fourth to eighth week of gestation as an etiological factor. In this review historical aspects and theories of the syndrome are studied and statistical data are compiled and analyzed. Clinical features, differential diagnoses and variants of the syndrome are examined. Testing and treatment objectives are discussed.

Enhanced Visualization of Capsulorhexis With Indocyanine Green Staining in Pediatric White Cataracts

PURPOSE To evaluate the enhancement of the visualization of the anterior lens capsule with indocyanine green (ICG) in pediatric dense, mature cataracts. PATIENTS AND METHODS Six children (10 eyes) 4 to 9 years old with complete, white cataracts underwent ICG-enhanced cataract surgery. RESULTS All of the eyes showed a complete continuous curvilinear capsulorhexis and a well-centered intracapsular implant. No surgical or postoperative complications were encountered. CONCLUSION Staining the anterior capsule with ICG is an excellent way to facilitate performance of an anterior capsulorhexis in pediatric white cataracts.

Cut and Paste: Sutureless Conjunctival Closure in Strabismus Surgery

PURPOSE This study investigated the use of fibrin glue and compared its effect with traditional sutures for conjunctival closure in strabismus surgery. METHODS The study included 12 patients undergoing horizontal strabismus surgery, of whom 5 underwent bilateral medial rectus muscle recessions and 7 underwent bilateral lateral rectus muscle recessions. For each patient, fibrin glue was used to close the conjunctiva of one eye and 6-0 plain sutures were used to close the other. RESULTS All eyes maintained adequate closure of the conjunctiva postoperatively and there were no intraoperative or postoperative complications for an eye. However, the average surgical time needed to apply fibrin glue was considerable less than that required for closure with sutures. Furthermore, eyes closed with fibrin glue were associated with significantly less postoperative inflammation and patient discomfort than those closed with sutures. All patients and parents reported significantly less discomfort from the eyes treated with fibrin glue. CONCLUSION These results are promising and demonstrated a safe and effective alternative to traditional suture closure in strabismus surgery. When compared to traditional suture closure, conjunctival closure with glue includes the following advantages: less postoperative patient discomfort, diminished postoperative inflammation, and potentially reduced surgical time with corresponding reduced time under general anesthesia.

Simplified Limbal Incision for Extraocular Rectus Muscle Surgery

We describe a limbal incision for extraocular muscle surgery which involves only one incision to the conjunctival-Tenons layer instead of the three separate incisions required in the standard limbal approach. Based on the 316 extraocular muscle operations in which we have used this one-snip procedure, we conclude that it is simpler and faster than the standard limbal incision, and that it provides good surgical exposure and probably less tissue damage.