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. |
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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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