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And Strabismus Second Edition Springer Science+Business Media, LLC Pediatric Ophthalmology and Strabismus Second Edition The following tables can be used as a guideline in planning Strabismus surgery. These numbers have been derived from Marshall Parks, with modifications from the surgical experience of Kenneth W. Wright. The numbers are only a guide and should be modified as necessary. BINOCULAR SURGERY Esotropia MROU LR OU ET Recession ET Resection* 1S~ 3.0mm 1S~ 3.Smm 20~ 3.Smm 20~ 4.Smm 2S~ 4.0mm 2S~ S.Smm 30~ 4.Smm 30~ 6.0mm 3S~ S.Omm 3S~ 6.Smm 40~ S.Smm 40~ 7.0mm so~ 6.0mm so~ 8.0mm 60~ 6.Smm 70~ 7.0mm * When a lateral rectus resection is clone for residual esotropia after large medial rectus recession (6.00 mm or larger), these numbers should be lowered. Exotropia LR OU MROU XT Recession XT Resection 1S~ 4.0mm 1S~ 3.0mm 20~ S.Omm 20~ 4.0mm 2S~ 6.0mm 2S~ S.Omm 30~ 7.0mm 30~ S.Smm 3S~ 7.Smm 3S~ 6.0mm 40~ 8.0mm 40~ 6.Smm so~ 9.0mm MONOCULARSURGERY Esotropia Exotropia MR LR LR MR ET Recession Resection XT Resection Resection 1S~ 3.0 mm ............... 3.S mm 1S~ 4.0 mm ................ 3.0 mm 20~ 3.S mm ............... 4.0 mm 20~ S.O mm ................ 4.0 mm 2S~ 4.0 mm ............... S.O mm 2S~ 6.0 mm ................ 4.S mm 30~ 4.S mm ............... S.S mm 30~ 6.S mm ................ S.O mm 3S~ S.O mm ............... 6.0 mm 3S~ 7.0 mm ................ S.S mm 40~ S.S mm ............... 6.S mm 40~ 7.S mm ................ 6.0 mm so~ 6.0 mm ............... 7.0 mm so~ 8.0 mm ................ 6.S mm 60~ 6.S mm ............... 7.S mm 70~ 7.0 mm ............... 8.0 mm THREE-MUSCLE SURGERY For large horizontal deviations, surgery on three musdes may be planned for the primary operation. The amount of surgery can be judged from the above tables. This works especially well in adults, where one musde can be placed on an adjustable suture. The adjustable suture should be clone on the eye for which two musdes are being operated. VERTICAL NUMBERS A rule of thumb for vertical surgery is 3 prism diopters of vertical correction for every millimeter of recession. Inferior rectus reces­ sions are notorious for late overcorrections; therefore, consider using nonabsorbable sutures or long-lasting absorbable sutures. Superior rectus recessions for dissociated vertical deviation (DVD) must be large, with the minimum recession of approximately 5 mm and a maximum of 9 mm (fixed-suture technique). KESTENBAUM PROCEDURE FOR NYSTAGMUS Face-turn to the RIGHT To correct the right face-turn (eyes shifted to a left null point), move the eyes to primary position by moving both eyes to the right. LEFT EYE RIGHT EYE Degree of Recess Resect Recess Resect Face-Turn LR MR MR LR Classic <20° 7mm 6mm 5mm 8mm Parks 30° 9mm 8mm 6.5mm 10mm Classic +40% 45° 10mm 8.5mm 7mm 11 mm Classic +60% 50° 11 mm 9.5mm 8mm 12.5 mm Pediatric Ophthalmology and Strabismus Second Edition Springer Science+Business Media, LLC Pediatric Ophthalmology and Strabismus Second Edition Editors Kenneth W. Wright, MD Clinical Professor of Ophthalmology, University of Southern California-Keck School of Meclicine Director, Pediatric Ophthalmology Research and Education Cedars-Sinai Medical Center Los Angeles, California, USA Peter H. Spiegel, MD Vision Professionals, Palm Springs, California Inland Eye Clinic, Hemet, California Attending Physician, Loma Linda University Medical Center Loma Linda, California, USA With 838 IDustrations in 1197 Parts, 694 in Full Color Illustrators Timothy C. Hengst, CMI Susan Gilbert, CMI Faith Cogswell Springer Kenneth W. Wright, MD Peter H. Spiegel, MD Clinical Professor of Ophthalmology Vision Professionals University of Southern California­ Palm Springs, CA Keck School of Medicine Inland Eye Clinic Director Hemet, CA Pediatric Ophthalmology Research and Education Attending Physician Cedars-Sinai Medical Center Loma Linda University Medical Center Los Angeles, CA, USA Loma Linda, CA, USA [email protected] [email protected] Library of Congress Cataloging-in-Publication Data Pediatric ophthalmology and strabismus / editor, Kenneth W. Wright, Peter H. SpiegeL- 2nd ed. p.; cm. Previous ed. cataloged under: Wright, Kenneth W., (Kenneth Weston), 1950-. Includes bibliographical references and index. 1. Pediatric ophthalmology. 2. Strabismus. I. Wright, Kenneth W. (Kenneth Weston), 1950- . Pediatric ophthalmology and Strabismus. II. Wright, Kenneth W. (Kenneth Weston), 1950- . ill. Spiegel, Peter H. [DNLM: 1. Eye Diseases-Child. 2. Eye Diseases-Infant. 3. Strabismus-Child. 4. Strabismus-Infant. WW 600 P37141 2002] RE48.2C5 W747 2002 618.92'0977--dc21 2002020934 ISBN 978-1-4899-0511-6 ISBN 978-0-387-21753-6 (eBook) Printed on acid-free paper DOI 10.1007/978-0-387-21753-6 © Springer Science+Business Media New York 2003 Originally published by Springer-Verlag New York, Inc. in 2003 Softcover reprint of the bardeover 2nd edition 2003 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher Springer Science+Business Media, LLC, except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer sofrware, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if the are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be tme and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. 987654321 SPIN 10874558 www.springer-ny.com To my beautiful wife Donna and my children Jamie, Matthew, Lisa, Michael, and Andrew for their unselfish love that allows me to pursue my passion: pediatric ophthalmology and Strabismus and To my mother, Mary Jo, and my father, Harvey, for their steadfast support that gave me the opportunity to fulfill my dream. Kenneth W. Wright, MD To my wife, Lori, for her love and support. Peter H. Spiegel, MD Foreward History of Pediatric Ophthalinology he editors of this excellent balanced text of Pe­ established in almost every metropolitan area of sig­ T diatric Ophthalmology and Strabismus re­ nificance. The new social demand for improved med­ quested a foreward to the first revised edition ical care for children swept the struggling specialty of to inform the younger readership about the historical pediatrics into prominence and acceptability. The re­ details of pediatric ophthalmology and how strabis­ sentment of general practitioners gradually disap­ mus became joined to pediatric ophthalmology. I ac­ peared and for good reason. Medicine, sooner or later, cepted the editors' challenging invitation with the un­ inevitably smothers any trace of self-interest and derstanding that the reader should realize that history shortsightedness by invariably asking the question, is notorious for being recorded according to its author's What is in the best interest of the patient? This atti­ memory, research, and point of view. This foreward is tude is the ingredient that makes medicine such a no exception to that observation. laudable profession. The answer was obvious, because Ophthalmology was one of the first specialties. time showed that pediatricians had raised the stan­ Having evolved from surgery, it was welcomed as a dard of care for infants and children. specialty because ophthalmology was concerned with We should be proud that ophthalmology fulfilled other sciences and instrumentation unfamiliar to gen­ the leadership role in the specialty movement by ini­ eral surgeons. Refraction, assessment of the alignment tiating a certification process. Conceived in 1916, and motility of the eyes, and attempting to compre­ this was the beginning of the American Board to cer­ hend the complex neurology of vision were so far out­ tify that candidates were adequately trained in their side the scope of knowledge expected of a general sur­ specialty and had passed an examination given by geon that the development of ophthalmology as a peers and superiors that validated competence to specialty brought a sense of relief to its progenitors. practice that specialty. Before certification, the pub­ In retrospect, as pediatric ophthalmologists today re­ lic was victimized by self-proclaimed specialists in­ flect an the evolution of ophthalmology from its be­ adequately trained and incapable of rendering qual­ ginning to the mid-20th century, they perceive the spe­ ity care. Such a hold new order in the specialty cialty to have been primarily a geriatric one. Little in movement was met with resistance, not only by that formative period focused an the recognition and some ophthalmologists but also by the other spe­ treatment of visual disorders in children. This per­ cialties. Approximately 25 years passed before certi­ ception is not a criticism; rather, it is an observation fication became accepted by all ophthalmologists and that the natural evolving process of ophthalmology 35 years before all specialties instituted their own preceded the evolution of pediatrics. boards. The American Board of Ophthalmology must In cantrast to ophthalmology, pediatrics evolved have considered itself vindicated by the fact that all from general practice with only a minimal difference boards of the more than two dozen specialties copied in the basic knowledge between practitioners of the the model it established. two fields, except for their experience with different Since the middle of the 20th century, subspecial­ age groups.
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