[Long term outcomes of chronic abducens palsy surgical treatment in children and adults]

Abducent nerve palsy is the most frequent of the acquired palsies and occurs rarely on congenital basis. It is widely recommened to wait at least 6 mohths for possible return of sixth nerve function. After this period we consider surgical management. Our retrospective comparative study evaluated long-term results of two methods for surgical treatment of chronic six nerve palsy in 118 pediatric and adult patiens who undergone surgery in the period from January 1990 to December 2005. Group A had 56 patients, in whom we performed a large recession of the medial rectus combined with a supramaximal resection of the lateral rectus. The Hummelsheim transposition procedure with or without resection of transposed half-tendon vertical muscle was performed in 62 patients of the B group. This procedure was always combined with recession of medial rectus. The augmented version of the transposition surgery resulted in a significantly better primary position of eyes postoperatively, than single graded recession-resection procedure of the horizontal muscles. The transposition surgery resulted in visible improvement in head posture and ocular alignment in the primary position, with partial restoration of abduction.

[Anterior transposition or myectomy of the inferior oblique muscle in vertical deviation--long-term results]

Anterior transposition of the inferior oblique muscle (ATIO) and myectomy of the inferior oblique muscle (MIO) are favorite methods for surgical correction of dissociated vertical deviation (DVD), including patients with simultaneous inferior oblique muscle overaction (IOOA). In our comparative, randomized study we evaluated whether anterior transposition improves the surgical outcome compared to myectomy of the inferior oblique muscle. We included 82 eyes of 46 patients, 44 eyes treated with ATIO and 38 treated with MIO. We observed the size of the preoperative and final DVD, grade of the preoperative and final IOOA, rates of reoperation, and complications. We found out that ATIO is an effective surgical approach in the treatment of DVD and it can be used in patients with or without IOOA. We found no statistically significant difference in postoperative outcomes between anterior transposition and myectomy of the inferior oblique muscle. Despite of it, we prefer unilateral ATIO to manage IOOA for its minor incidence of secondary hyperfunction of contralateral inferior oblique muscle.

[Surgery of Duane retraction syndrome I: comparison of unilateral recession and resection versus bilateral medial rectus recessions]

The purpose of this comparative study was to evaluate a long-term efficacy of lateral rectus muscle resection in the affected eye of patients with Duane retraction syndrome (DRS) with esotropia and limited abduction and to compare it with bilateral medial rectus recessions. We reviewed and compared the data of the group A with 23 patients who underwent a recession-resection procedure and the group B with 26 patients in whom we performed medial rectus recessions. In each group, we evaluated pre- and postoperatively the ocular alignment, head position, ocular ductions, severity of retraction, and binocular visual field. Statistical analysis of the data was performed. Postoperatively, both groups had similar mean esotropia and mean face turns. However, the mean limitation of abduction in the affected eye was greater in the group B, mean adduction was also significantly worse in the group B. Globe retraction improved in all subjects of the group B, but worsened in 6 patients of the group A. Seventeen of 23 patients with Duane retraction syndrome, selected on the basis of esotropia, limited abduction, and mild retraction, benefited from a recession-resection procedure in the affected eye. The ability of abduction achieved higher level than in the group B after bilateral medial rectus recessions. We assume that unilateral recession-resection procedure should be performed in patients with mild retraction of the globe and good preoperative adduction.

[Eye involvement of borrelia aetiology]

We present a case of eye involvement -- intermediate uveitis -- during tick-borne borreliosis in a 10-year-old boy. Ophthalmologic examination revealed impaired vision, apparent thick floating whitish opacity in the vitreous humour of the left eye and fine fibres in the vitreous humour of the right eye. Sonographic examination confirmed hyperechogenic opacity in the vitreous humour. An autoimmune process was suspected but not confirmed. Serological examination showed IgG antibodies against three pathogenic borreliae and borderline values of IgM antibodies against Borrelia garinii were found by immunoblot. The boy was treated with intravenous ceftriaxone for 21 days. The subsequent sonographic examination showed only minute sporadic echogenicity. Biomicroscopically, only residual opacity in the vitreous humour was found. Isolated eye involvement of borrelia aetiology is rare. The discussion provides a review of similar cases of uveitis including diagnosis of the eye form as published in literature.