A randomised comparison of bilateral recession versus unilateral recession-resection as surgery for infantile esotropia

OBJECTIVE

Infantile esotropia, a common form of strabismus, is treated either by bilateral recession (BR) or by unilateral recession-resection (RR). Differences in degree of alignment achieved by these two procedures have not previously been examined in a randomised controlled trial.

DESIGN

Controlled, randomised multicentre trial.

SETTING

12 university clinics.

PARTICIPANTS AND INTERVENTION

124 patients were randomly assigned to either BR or RR. Standardised protocol prescribed that the total relocation of the muscles, in millimetres, was calculated by dividing the preoperative latent angle of strabismus at distance, in degrees, by 1.6.

MAIN OUTCOME MEASURE

Alignment assessed as the variation of the postoperative angle of strabismus during alternating cover.

RESULTS

The mean preoperative latent angle of strabismus at distance fixation was +17.2 degrees (SD 4.4) for BR and +17.5 degrees (4.0) for RR. The mean postoperative angle of strabismus at distance was +2.3 degrees (5.1) for BR and +2.9 degrees (3.5) for RR (p = 0.46 for reduction in the angle and p = 0.22 for the within-group variation). The mean reduction in the angle of strabismus was 1.41 degrees (0.45) per millimetre of muscle relocation for RR and 1.47 (0.50) for BR (p = 0.50 for reduction in the angle). Alignment was associated with postoperative binocular vision (p = 0.001) in both groups.

CONCLUSIONS

No statistically significant difference was found between BR and RR as surgery for infantile esotropia.

Full macular translocation versus photodynamic therapy with verteporfin in the treatment of neovascular age-related macular degeneration: 1-year results of a prospective, controlled, randomised pilot trial (FMT-PDT)

BACKGROUND

The purpose of this study was to compare full macular translocation (FMT) with photodynamic therapy (PDT) in the treatment of neovascular age-related macular degeneration (AMD).

METHODS

In a prospective, randomised, non-masked, mono-center, pilot-trial, 50 eyes of 50 patients were assigned to either FMT or PDT. Baseline and control examinations in 3-monthly intervals over a 12-month period included standardized protocol refraction, visual acuity testing and fluorescein angiography. Primary outcome measurements were made to establish the change in distant visual acuity from the baseline to the 12-month examination. The statistical analyses were carried out on the intent-to-treat principle.

RESULTS

The improvement of one or more ETDRS lines was 56% (14/25) of the eyes in the FMT and 16% (4/25) of the eyes in the PDT arm (P = 0.007). Twenty eyes (80%) in the FMT and 16 eyes (64%) in the PDT group had less than three ETDRS lines of vision loss (P = 0.35). Retinal detachment (six eyes) and diplopia (five patients) were recorded in the FMT group. None of the eyes treated in the FMT group had phtysis.

CONCLUSION

This pilot study showed that no statistically significant difference existed between the FMT and PDT in terms of the vision loss of less than three ETDRS lines in eyes with neovascular AMD. The chance of vision improvement was significantly higher for the patients in the FMT group. However, in the era of promising therapy with anti-vascular endothelial growth factor for neovascular AMD, FMT should not be offered as a standard primary procedure for neovascular AMD.

[Choroidal effusion syndrome after embolization of an indirect cavernous sinus fistula via the superior ophthalmic vein]

Embolization of a cavernous sinus fistula (SCF) via the superior ophthalmic vein (SOV) was reported to be an almost uncomplicated procedure, even after ligature of the vein at the end of the procedure. We report about a complication of this therapy. A 58-year-old female had a successful embolization of a right indirect cavernous sinus fistula via the SOV. At the end of the operation the SOV was ligated because of the danger of bleeding. Directly after surgery she experienced general worsening of the right eye with signs of venous congestion and marked effusion syndrome. The patient underwent total heparinization to achieve an opening of venous collaterals. Under local therapy with atropine 1% eye drops a decrease of the intraocular pressure was observed. The effusion syndrome was completely resolved within 1 month. If embolization of a cavernous sinus fistula is performed via the SOV, the ligature of the vein at the end of the procedure leads to thrombosis, which can reduce the venous stream from the eye and orbit. A secondary effusion syndrome with ocular hypertension because of a ciliolenticular block situation is possible and requires appropriate therapy. It is not possible to assess the capacity and time of opening of the venous collateral system before surgery. Therefore a transient outflow disturbance should be considered.

The locus of fixation in strabismic amblyopia changes with increasing effort of recognition as assessed by scanning laser ophthalmoscope

PURPOSE

We performed a qualitative assessment of fixation behaviour in relation to the fovea in patients with strabismic amblyopia.

METHODS

The fixation of 25 patients with strabismic amblyopia was examined using a scanning laser ophthalmoscope (SLO). A digital frame grabber board was programmed to scan onto the patient's retina single solid black discs of 5, 10 and 15 degrees in diameter and Landolt Cs in different orientations and corresponding to a visual acuity (VA) of 0.01-0.2 in European decimals. The relative position of the fovea was video-recorded. Fifty video fields per second were plotted as x/y (fixational positions in relation to the fovea) and x/t (motion over time) graphs.

RESULTS

Three main groups of patients were seen. Group 1 (n = 6), with a VA of < 0.1, showed a grossly eccentric and unstable locus of fixation independent of size/type of test stimulus used. Group 2 (n = 15), with VA of 0.1-0.8, initially used an eccentric retinal area for fixation that, however, shifted to the fovea with decreasing size and increasing detail of the target for fixation. Group 3 (n = 4), with VA of 0.3-0.8, had stable central fixation throughout.

CONCLUSIONS

We speculate that the reduced VA associated with strabismic amblyopia is due to a defective motor control of fixation that can be modulated by recognitional effort.

Ist der einseitige Strabismus sursoadductorius eine paretische Störung? - Kernspintomographische Untersuchungen

BACKGROUND

Recent reports postulate that the concomitant vertical deviation found in congenital superior oblique palsy is due to mechanical abnormalities rather than a congenitally paretic muscle, and is overcome in most patients by fusion. On the basis of the clinical characteristics alone a primary paresis is indeed unlikely. Although intraoperatively a different elasticity of the superior oblique tendon exists in congenital versus acquired cases of superior oblique palsy, preoperatively performed MR imaging shows that the clinical findings in congenital superior oblique muscle malfunction could nevertheless be of paretic origin.

MATERIALS AND METHODS

Seventeen consecutive patients (males: n = 13; females: n = 4) were examined. The vertical deviation in adduction was concomitant in vertical versions, the excyclotropia was small and concomitant in all directions of gaze and was less than 10 degrees even after diagnostic occlusion. All patients showed a positive Bielschowsky head tilt phenomenon and large fusional ability. We performed preoperative MR imaging of both orbits in high resolution 3 mm sections in coronal and axial orientations with and without contrast enhancement.

RESULTS

In sixteen patients we found a significant reduction in muscle volume or even total aplasia of the superior oblique muscle of the affected side in comparison to the sound muscle on the other side. In contrast, two patients had a full blown clinical picture of a congenital superior oblique palsy but showed symmetrical muscle volumes on both sides in all coronal sections.

CONCLUSIONS

Hypoplasia or aplasia of the superior oblique muscle on magnetic resonance imaging provides evidence for a primary paretic cause for the vertical squint found with congenital superior oblique dysfunction. It is not clear, however, whether this is caused by a primary hypoplasia or is of neurogenic origin. Our data together with the consistent difference in tendon morphology of the congenital and acquired forms of superior oblique palsy seem to exclude a purely neurogenic cause for the affection.

[Interocular inhibition in strabismus]

Many patients with acquired strabismus do not suffer from diplopia and confusion after an individually and age-dependent interval. They inhibit the image of the deviated eye by binocular rilvary and particularly by the physiological ability to disregard visually disturbing stimuli. In strabismus with early onset, binocular rivalry is also demonstrable, even for stimuli that do not normally lead to suppression. On the basis of anomalous retinal correspondence, this rivalry occurs between retinal points onto which the same object projects. The retinal area with the lesser eccentricity receives the dominance. The fovea of the deviated eye is therefore not suppressed. In small-angle strabismus with smaller functional differences between anomalous corresponding retinal points anomalous fusion and even stereopsis can be possible as long as strong suprathreshold stimuli are presented. Strabismic amblyopia as a consequence of interfoveal suppression can only develop before anomalous retinal correspondence dominates in the strabismic child.

[Long-term outcome of optic nerve sheath fenestration in pseudotumor cerebri]

BACKGROUND

Chronic papilledema may lead to irreversible damage of optic nerve fibers. To preserve visual functions, a decompression of the optic nerve is recommended by means of a fenestration of the optic nerve sheath. In this study long-term results after optic nerve sheath fenestration in patients with idiopathic pseudotumor cerebri are reported.

PATIENTS AND METHODS

14 patients were re-examined 15 to 145 months (mean 62 months) after a fenestration of the retrobulbar optic nerve sheath on 23 eyes by a transconjunctival approach. Surgery was done to treat progressive visual loss or in severe obscurations. The patient's symptoms, visual acuity, visual fields, and ophthalmoscopic findings of the optic nerve head and the central fundus were compared to the preoperative status.

RESULTS

Re-examination revealed improvement or stabilisation of objective and subjective findings in 17 eyes, one of them was operated on the more involved contralateral side only. Six eyes showed a recurrence of the papilledema without a functional change for the worse after an interval of 7 to 121 months. Three eyes of two patients ended up with optic atrophy and extensive visual loss. Preoperatively, these eyes had shown cotton wool spots in the optic nerve head and a rapid deterioration of vision.

CONCLUSIONS

Fenestration of the retrobulbar optic nerve sheath can prevent further visual loss in most patients with pseudotumor cerebri, unless the eye has already become nearly blind. Postoperatively, ophthalmological controls are necessary at regular intervals because relapses after successful surgery can occur after months or years.

[Conjunctival cysts of the orbits: clinical aspects and histology in 4 patients]

BACKGROUND

Only a few reports concerning congenital conjunctival cysts of the orbit (primary nonkeratinized epithelial cysts) have been published.

PATIENTS

We describe four further cases of conjunctival cysts of the orbit, which were observed between 1995 and 1997 in Tübingen and Vienna. Histologically, all cysts were lined by nonkeratinizing epithelium with goblet cells. Epidermal appendages were found in the wall of one cyst. The patients' age was between 1 and 32 years. Clinically, the prominent symptom was swelling of the upper eyelid, persisting in three patients for more than several years. In one patients diplopia and restriction of eye movements developed within several weeks.

CONCLUSIONS

The cases we described are in accordance with the cases reported in the literature. Often a swelling of the upper eyelid persisted for several years, before the cyst has become symptomatic predominantly in an adult patient. In contrast to dermoid or epidermoid cysts, there is no bony erosion and the cysts are located in the superior to nasal orbit. These cysts are probably more common as it is represented in the literature.

[Insufficiency of a frontalis loop]

After 13.5 years in vivo a 2-0 Terylene frontalis loop was excised because of an insufficiency. Histology showed a persisting giant cell reaction while lymphocytes were almost totally absent. The fibrils of the suture seemed to be intact. However, they were separated by ingrowing connective tissue which, on theoretical grounds, should improve the function of the frontal muscle on the upper eyelid. Therefore, insufficiency of the loop was probably caused by the (subclinical) foreign body reaction or the long-lasting mechanical stress leading to tissue damage.

Ocular myasthenia gravis: response to long-term immunosuppressive treatment

OBJECTIVE

Ocular myasthenia gravis is a subtype of myasthenia gravis that causes relatively mild disability, but may convert into severe generalised muscle weakness. A universal management plan for ocular myasthenia gravis has not been established. This study was performed to determine the outcome of ocular myasthenia gravis with the currently available therapeutic options.

METHODS

Retrospective analysis of 78 patients with ocular myasthenia gravis with a mean disease duration of 8.3 (range 0.5-58.3) years.

RESULTS

In 54 patients (69%) symptoms and signs remained confined to the extraocular muscles during the observation period. The remaining 24 patients (31%) developed symptoms of generalised myasthenia gravis; 50% of them within two years, 75% within four years after onset. A somewhat reduced risk of generalisation was found in those with mild symptoms, normal repetitive nerve stimulation test, and low or absent antiacetylcholine receptor (AChR) antibodies at the time of diagnosis. Patients receiving immunosuppressive treatment (corticosteroids and/or azathioprine) rarely developed generalised myasthenia gravis (six of 50, 12%). Those without such treatment, usually due to uncertain diagnosis and late referral, converted into generalised myasthenia gravis significantly more often (18 of 28, 64%).

CONCLUSIONS

The prognosis of ocular myasthenia gravis is good. A conventional scheme with short-term corticosteroids and long-term azathioprine seems adequate to achieve remission in most patients. The proportion of patients developing generalised myasthenia gravis was smaller in this population compared with previously published groups (usually 50%-70%). Early immunosuppressive treatment is at least partially responsible for this finding. Thymectomy (performed here in 12 patients with an abnormal chest CT) also correlated with a good outcome, but had no apparent advantage over medical treatment alone.

How useful is anomalous correspondence?

In anomalous retinal correspondence (ARC), retinal points in the right and left eyes which receive stimuli from one object in space have the same visual direction despite a manifest motor deviation. The mode of cooperation of these anomalously corresponding retinal points depends on their relative eccentricity or their relative functional level. If there is a great difference, as for the most part in large angle strabismus, the retinal point with less eccentricity and better resolution will prevail, while the other will be suppressed. This leads to a second area of high resolution in the binocular visual field with a possibly irritating effect. In microtropia, anomalous corresponding retinal points have functionally different levels only in the very centre of the visual field. ARC provides in this case a binocular cooperation very similar to normal fusion. To an individually different degree, ARC can adapt to new squint angles, which makes squint surgery possible without postoperative diplopia, but a change to normal binocularity with stable interocular connections can not be achieved. ARC enables the heterotropic patient to see with both eyes simultaneously without diplopia by a regionally changing use of inhibition and anomalous fusion in the interest of the best possible perception.

[Pathogenesis of eso- and hypotropia in high myopia]

BACKGROUND

In myopia characteristic types of strabismus and defects of ocular motility can occur. One of these myopia related disturbances shows a gradually increasing eso- and hypodeviation in progressively myopic eyes, caused by a corresponding deficit of abduction and elevation. Different pathogenetic factors have been described for this long known clinically uniform entity.

PATIENTS AND METHODS

In eight patients with pathologic myopia a marked eso- and hypotropia was operated on in the last 15 years. The deviation was infantile in two and acquired in six cases. We performed a routine orthoptic examination and looked for anatomic variations of the rectus muscles during surgery.

RESULTS

In seven of the eight cases the anterior portion of the lateral rectus muscle was not directed straight dorsaly but obliquely into the lower temporal quadrant of the orbit. A supraposition of the horizontal recti muscles in addition to a recess-resect procedure provided satisfactory results in five of six cases.

CONCLUSIONS

Scleral ectasia in high myopia can lead to a downslip of the lateral rectus muscle relative to the globe, giving this muscle a depressing effect at the cost of its physiological action. As in Duane's syndromes with up- or down-shoot, a repair of the deviation is possible by combining horizontal surgery with vertical transposition of the horizontal recti muscles. Additional operations on the vertical recti muscles can thus be avoided.

[The value of the prism adaptation test in determining the degree of squint surgery]

The angle of squint deviation was measured preoperatively before and after a prism adaptation of 1 day's duration in 50 esotropic and 45 exotropic patients. All had a deviation of 17 degrees or more under prismatic correction and were operated on by a recess-resect procedure of 10 mm on one eye. Postoperative measurements were done about 4 days and 6 weeks after surgery. In 58% of the esotropic and 37% of the exotropic patients, the initial deviation increased under prisms. This was found most often when normal retinal correspondence was present. There was a correlation between the effect of surgery with the change of deviation under prisms, particularly in normosensory esotropia and intermittent exotropia. Accordingly, the standard deviation of the surgical effect was smaller in this group, when it was calculated from the deviation under prisms in comparison to a calculation from the primarily measured angle. The influence of the preoperative deviation on the effect of a 10-mm recess-resect procedure was also found for the deviation under prisms and must therefore additionally be mentioned in the dosage of surgery. This retrospective study shows that preoperative prism adaptation improves predictability of the effect in squint surgery, at least in normosensory esotropia and intermittent exotropia. In patients with early-onset strabismus prism adaptation does not improve predictability, but higher dosage seems to be useful in cases with increased deviation under prisms and did not lead to over corrections. In this group the test represents an additional method for evaluation of the binocular sensory status.

Neuroepithelial adenocarcinoma of the eye

A 29-year-old male patient with a microphthalmos on the right side since birth was seen in June 1987 in the University Eye Clinic because of a massive exophthalmus of the former microphthalmic eye. Computer tomography revealed a diffuse, infiltrating tumor of the right orbit. The bulbus was not demarcated, and the whole orbita had to be eviscerated. Histologically, we found a solid, undifferentiated tumor with clear signs of malignancy. It consisted of epithelial cells, partly in nest formation, which were keratin positive and vimentin negative, and of more spindle-shaped formations which were keratin negative and vimentin positive. In some areas, the tumor showed a tubular or an adenoid proliferation. CEA or S-100 could not be demonstrated. The histopathological diagnosis was neuroepithelial adenocarcinoma of the eye. The differential diagnosis and the genesis of the tumor are discussed.

The diagnostic value of serum autoantibodies in endocrine orbitopathy and idiopathic ocular myositis

Sera of patients with Graves' orbitopathy (GOP) often contain antibodies against retroorbital tissue components. The presence of such autoantibodies has been considered to indicate an autoimmune pathogenesis of the disease. However, their specificity has not been conclusively tested, because studies demonstrating autoantibodies used controls with no lesion in the extraocular eye muscles. Although ocular myositis (OM) is clinically distinct from GOP, damage to the retroorbital muscles is a common histopathological finding in both conditions. Using an immunoblot technique, reactions of sera from patients suffering from either disease were compared. Sera from both groups contained antibodies against a variety of antigenic determinants recognized by both sera. These autoantibodies may have been induced secondary to tissue damage and should be considered to be nonspecific. Because the role of tissue damage was not accounted for in previous studies, evidence concerning antigens supposedly specific for GOP should be reevaluated. The reaction patterns of OM and GOP sera were slightly different. These differences were specific enough to suggest that sera from patients with GOP contain antibodies against eye muscle components that are not present in the sera of patients with idiopathic OM. These findings support the assumption that GOP is an autoimmune disease. However, the major autoimmune targets remain to be identified and their pathogenic relevance is still unclear.

Infantile exotropia with homonymous hemianopia: a rare contraindication for strabismus surgery

A homonymous hemianopia can be compensated by a strabismus in the direction of the visual field defect if the deviated eye has a harmonious anomalous localization. This compensation is only partial; its extent corresponds to the angle of deviation. We report on two patients with a hemianopia to the left. Under binocular conditions the visual field defect was reduced by an exotropia of the left eye with panoramic vision. Unfortunately, up to now it has not been possible to induce such a sensory-motor compensation in cases of homonymous hemianopia with normal retinal correspondence in an adult visual system.

[Cystic teratoma of the orbit]

Teratomas are rare cystic tumors of the orbit which lead to excessive congenital exophthalmos. They increase rapidly in size after birth and therefore require immediate surgical treatment. Initial puncture of the cyst under sonographic control prevents progressive mechanical damage to the globe and the optic nerve, providing sufficient time for the preoperative measures required prior to final surgical removal. The characteristic clinical features make it easy to identify a teratoma provided it has been taken into consideration in the differential diagnosis. It is shown with reference to one of the authors' own cases that a good functional result is possible after removal of the encapsulated tumor with preservation of the globe, even when the eye has been excessively displaced by the tumor.

Objective and subjective evaluation of cyclovergence and cyclofusion

There is a marked dispersion in the measured results of the angle formed by the intersection of the optic disc-center-meridian with the horizontal meridian, when the cycloposition of the eyes is determined through evaluation of the position of the optic disc (with fundus photographs or indirectly with perimetry). Values of the angle ranging from 0 degree at 12 degrees are still physiological. Inside this dispersion, individual right-left asymmetries of less than 4 degrees with photography and of less than 7 degrees with monocular perimetry are still normal as well. Positional differences of less than 4 degrees in sequential testings are also in a physiological range. The motor behaviour of both eyes during cyclofusion is evaluated by means of a perimetrical analysis of the blind spot at the phase-difference haploscope. Various sensory and motor adaptation phenomena are detected by comparing objective and subjective findings in patients with cyclotropia. These phenomena are discussed in detail.

[Anomalous bilateral single vision in cases of severe squint deviation: investigations with Bagolini glasses (author's transl)]

Twenty patients with concomitant strabismus, ARC and a horizontal deviation of between 10 and 30 degrees (13 convergent, seven divergent) were examined with striated glasses to determine areas of anomalous simultaneous binocular vision. Such an area was found in a zone between the visual field centers of the two eyes in 18 cases. On the basis of these findings the authors suspect that harmonious ARC permits anomalous binocular vision only in field areas where retinal points with identical images have no significant difference in function. In the other areas of the binocular visual field, ARC provides for optimal perception of detail by suppression of the more peripherally situated retinal point.

[The A and V phenomenon and squint operations (author's transl)]

In 140 cases with strabismus of early onset the change of a A or V pattern was examined after a weakening procedure of the oblique muscles or a vertical transposition of the horizontal rectus muscles of one eye was done. The horizontal incomitance was measured between up and down gaze of 20 degrees. In cases with pronounced overaction of the oblique muscles we performed a recession of the inferior oblique or a tenotomy of the superior oblique respectively. If there was no significant vertical deviation we combined the recession- resection procedure with a vertical transposition of 4 to 50 mm. 75% of all cases showed a reduction of the incomitance (3 degrees or more). In average the preoperative pattern was reduced 70%. The most effective procedure was the bilateral superior oblique tenotomy, and the weakest the vertical transposition against the A- pattern.--In 95 cases with a A or V pattern only a horizontal recession-resection procedure was done. 38% showed a change of the preoperative incomitance but the average reduction was under 2%.

[Signs and symptoms of endocrine orbitopathy (author's transl)]

The typical motility disturbances of endocrine orbitopathy and the methods of examination are described. Particular reference was placed on the active force generation test and the passive forced duction test. The differential diagnosis between endocrine orbitopathy and tumor was described. Occasionally the endocrine infiltrations may lead to retinal folds or to a tumour-like echographic picture.

[Stereoscopic vision with alternating presentation of stereo pairs (author's transl)]

The threshold values for stereopsis with alternating monocular presentation of the corresponding member of a stereo pair was examined in relationship to the stimulus duration and the interocular delay. The maximum interocular delay for short stimulus durations was approximately 190 msec. The maximum stimulus duration was between 400-500 msec. At this stimulus duration the interocular delay must approach zero if stereopsis is to be maintained. In the threshold region the stereo effect diminished. One can possibly explain this phenomenon as a partial sensorial fusion. For normal appreciation of stereopsis, the critical frequency was about 2 Hz over the threshold values found with a given stimulus duration.

[Aberrant reinnervation after oculomotor palsy with involvement of the ciliary muscle (author's transl)]

The clinical and electromyographic signs of the misdirection syndrome after oculomotor palsy are described. Besides the previously described findings we found an increase of intraocular pressure dependent on the direction of gaze. In three young patients (16-26 years), we were able to demonstrate an aberrant reinnervation of the ciliary muscle, which was responsible for an increasing myopia in adduction. These observations supplement the previous concept of the misdirection syndrome.

[Examination of retinal correspondence with minimal dissociation (author's transl)]

With the phase difference haploscope the incidence of anomalous retinal correspondence in patients with convergent strabismus was examined with respect to the degree of deviation, the duration of squint and the fixation pattern of the deviated eye. Anomalous correspondence was found more often when small angles were present, in older patients and in cases with excentric fixation. Even when the deviation exceeded 19 degrees and the fixation was central, we observed harmonious anomalous correspondence in 30% of cases, The evaluation of the correspondence in children with esotropia and central fixation by means of paradoxic diplopia after correction of the deviation with prisms revealed harmonious anomalous correspondence more often than with the phase difference haploscope, although the conditions of casual seeing are changed in this test. We have attempted to ascribe these findings to simultaneous stimulation of the central retinal areas of both eyes, the nearly unlimited visual field and the short binocular exposure of the pictures in our method. Finally we described our first experiences with a modified Kongruenztest. With this simple technic it is possible to examine the state of correspondence under conditions of casual seeing.

[Fixation disparity under various test-conditions (author's transl)]

Measurements of fixation disparity and Panum areas were performed with a special device of the phase-difference haploscope in normal persons. There was a reproduceable influence on fixation disparity and size of Panum areas, when the conditions of examination were changed (position of the binocular fusion-pattern, brightness and contrast of the targets for sensory fusion and time of prism wearing). There found we found only under comparable conditions a quantitative relationship between the two phenomenons.

[Examination of stereoscopic vision with the phase-difference haloscope (author's transl)]

The authors report on the possibilities for examination of the stereoscopic vision at 2 or 4 meters by the phase-difference-haploscope. Besides a gross-qualitative test, methods of estmating realdepth acuity are described. There is a great variability of test-conditions for special scientific problems. During the routine examintion of disturbed binocular vision it is possible to test the stereo acuity, even if there is squint or aniseiconia.

[Signs, therapy and follow-up of cases with pure blow-out fractures of the orbit (author's transl)]

30 patients with blow-out fractures were referred to our clinic because of serious "eye troubles", most frequently diplopia and haematoma of the eye lids (Table 1). The signs of the characteristic oculomotor imbalance are described. In 10 out of 29 patients motility was normalised spontaneously within 2 weeks. 19 patients underwent surgery because one of the following criteria was fulfilled: 1. Diplopia and positive traction-test not resolving within 10 days. 2. Large hermiation into the antrum. We believe, that posttraumatic diplopia is not only a result of the incarceration, but also of a direct laesion of muscles and connective tissue. Surgery was done by orbital approach. After reposition of antral prolaps and the bony fragment we used Lyodura or, when nessessary, silicon implants. In all patients treated in this way ocular motility was improved, but normalisation was achieved only in 8 cases (Fig. 8).