We investigated the clinical factors affecting the development of consecutive exotropia following esotropia surgery. The development period of consecutive exotropia, amblyopia and limitation of adduction were evaluated in 89 patients with primary esotropia that changed to consecutive exotropia after surgery. In the presence of deep amblyopia, consecutive exotropia developed earlier. When two horizontal muscles were operated, limitation of adduction was more frequent in symmetrical rather than asymmetrical surgical procedure. Since consecutive exotropia may develop many years after esotropia surgery, a long-term follow-up period in patients without consecutive exotropia in the early postoperative period is advised.
The acute effect of traumatizing events on the human brain has long been studied. The major obstacles to this endeavor have been the severity and the delay from time of exposure to the traumatizing events. To avoid these issues, EEG and clinical examinations of 18 healthy, drug-free subjects were performed 2 weeks after an earthquake occurred in Turkey in 1999. It was found, for the first time to our knowledge, that EEG parameters can predict startle response in acute stress reaction correctly in 100% of the cases. EEG measures of the reactivity to eyes opening were especially important in this regard.
We encountered a 5-year-old girl with acute onset of alternating, comitant esotropia in the absence of diplopia and other neurologic findings. She did not have any refractive error and seen bilateral papilledemas in fundus examination, magnetic resonance imaging (MRI) of the head was performed. A large cerebellar astrocytoma and moderate hydrocephalus was identified and successfully resected. The onset of comitant esotropia in a child can be the first sign of a cerebellar tumor without any other neurologic signs and symptoms.
Background: Congenital esotropia has a deviation of 50 or more prism diopters (Δ). Generally, surgical alignment of the eyes is the accepted treatment but surgical techniques differ.
Methods: A total of 54 patients were evaluated. Surgery was done at a mean age of 28 months. Bimedial rectus recessions up to 8 mm were performed.
Results: The mean preoperative deviation was 70 Δ of esotropia. Our success rate with a uniform approach was 66.6%.
Conclusions: Contrary to the selective approach for large angle congenital esotropia, we do not consider initial surgery on three or more muscles. Our method is quicker, simpler, less traumatic, and leaves the lateral rectus muscles unoperated for patients requiring a second surgery.
Journal of Pediatric Ophthalmology and Strabismus 1999;36:201-205.
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