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  Česky / Czech version Čes. a slov. Oftal., 59, 2003, No. 6, p. 402 - 414
 
Indication for Refraction Intervention in Adult Patients with Strabismus and the Results of Subsequent Therapeutic Procedure 
Krásný J., Brunnerová R., Kuchynka P., Novák P., Cyprichová J., Modlingerová E. 

Oční klinika FN Královské Vinohrady, Praha, přednosta prof. MUDr. P. Kuchynka, CSc.
 


Summary:

       The authors estimated the contribution of the refraction intervention and a possible evolution in the position of eyes in 102 adult individuals considering a refraction intervention. The indications for this intervention were a disorder in eye position or amblyopia in those who were interested in this operation and were examined in the years 1996 to 2002. The basic refraction examination was always supplemented by a detailed orthoptic analysis. Based on this examination the intervention was not recommended in 14 examined subjects (14%). ARK represented the contraindication of the refraction intervention in 9 patients, since subsequent changes in the size of the deviation or operation adjustment of strabismus could result in diplopia. An excessive convergence with a high AC/A in hyperopia was also considered as an unsuitable indication, since a lasting cosmeticandfunctional significantconvergentdeviationintoneardistances could not be excluded. Five patients declined from the refraction intervention on the basis of this explanation. The paper is mainly dealing with an analysis of the development of position of the eyes and binocular functions in 46 adult patients, who decided to undergo a refraction intervention and further orthoptic care after a complex stroboscopic and refractionexamination.Theadjustment of refractive errorwasmade by theLASIK methods (Laser in Situ Keratomileusis) on 69 eyes (80 %) and CLE (Cleans Lens Extraction) on 17 eyes (20 %). The orthoptic analyses before and the refraction intervention revealed that in all 29 even only partially accommodating esotropia, the deviation was diminished after the refraction intervention on the average by +11.2 degrees (in the rage of +2 degrees to +30 degrees) to 5.4 degrees (in the range of parallel position to +20 degrees) in the predominantly represented hyperopia, but also in 6 myopias. The improved position of the bulbs was not directly associated with the degree of hyperopia with the original deviation.The deviation after the refractioninterventionin23 patients (79%) with esotropiawasnot higher than +5 degrees. The cosmetic position of the eyes was completely satisfactory and did not therefore represent even indication for the operation. The 9 patients (35%) with esotropia and hyperopia there ware an improvement of binocular functions. It could be theoretically due to the newly developed emetropia making permanent optimal sensory information possible. In all 17 exotropias there were not any significant changes in the size of deviation and the binocular functions were not reestablished, if they were not retained before. The position of eyes was solved surgically in 12 patients, while exotropia predominated in two thirds of them. The weakening or strengthening interventions on horizontal straight muscles were selected according to character of strabismus in 11 patients. Recession of the lower oblique muscle was indicated one case only for the simultaneously present torticollis with exotropia. The residual deviation was not greater than 5 degreesimmediately after theoperation or duringthe followingmonths.Binocular functions were not reestablished in any patients. A alternate suppression or suppression of perception on one eye were proved.

        Key words: binocular vision, CLE, LASIK, strabismus, refractive errors
       

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