Simultaneous Horizontal and Cyclovertical Strabismus Surgery

Thirty years ago, our attention was drawn to the alphabetical incom itances in strabismus. As an elevation in adduction is the most frequent incomitance, we decided to start treating these incomitances. A weak ening procedure of the inferior oblique muscle seemed indicated. How ever, since we wanted to prevent a torsional overcorrection with a head tilt, we displaced the scleral insertion of the oblique muscle towards the equator of the globe. This way, the torsional action of the muscles is saved. A weakening of the horizontal rectus muscles was systematically added, making it a simultaneous horizontal and cyclovertical surgery. Our way to deal with strabismus developed into a coherent entity and the interest of colleagues encouraged us to write it down.We decided to publish a textbook with a theoretical and an extensive practical part. Our approach is based on thirty years of exclusive strabological work, half-time academic and half-time private practice. More than 6500 re sults were analysed and the majority have been published. The con cerned publications are referred to at the end of the first chapter. Private practice allowed to benefit from the fact that patients were operated on by the same surgeon and remained in personal contact during follow-up.

Texte du rabat

Thirty years ago, Gobin and Bierlaagh developed the simultaneous horizontal and cyclovertical strabismus surgery that became a recognized, albeit much debated method, but no manual on the subject was available until now. The book is aimed at ophthalmologists interested in strabismus. It is also intended for orthoptists, in view of the importance of examining ocular motility. Although the ophthalmologist remains responsible for the surgical indication, the active participation of the orthoptist is advantageous. The analysis of incomitances of the eye movements is discussed extensively, as it is the keystone of simultaneous surgery. For the same reason, great attention is given to the surgical indications. The chapter on oculomotor disturbances is completed with a series of examples of the most common motility disorders and the indications for their surgical treatment. Surgery is covered in detail. Primary surgery is discussed in the same section as surgery for under and overcorrection. Since a correct sequence of the different surgical acts is essential for a smooth intervention, the technique of operating rectus as well as oblique muscles is presented in a clear, step-by-step manner. The last chapter deals with the complications such as limitation of duction, postoperative diplopia and the change in palpebral fissure. The book contains approximately 380 black and white illustrations in 270 figures and 94 colour plates, illustrating surgical techniques. The work is based on an analysis of more than 6500 cases.

Contenu
I. Introduction.- 1.1. History.- 1.2. Sagittalisation of the oblique muscles.- 1.3. Hemiretinal suppression.- 1.4. Conclusions.- 1.1. References.- II. Methods of examination.- II. 1. Torticollis.- II. 2. Hirschberg's test.- II. 3. 15 Dioptre prism test.- II. 4. Cover test.- II. 5. Examination of binocular vision.- II. 6. Measurement of the objective angle of deviation.- II. 7. Examination of ocular motility.- II. 8. Assessment of amblyopia.- II. 9. Refraction.- III. Conservative treatment.- III. 1. Management of amblyopia.- III.2. Management of ametropia.- III. 3. Management of esodeviations.- 1.1. References.- 1.1. References.- III. 4. Management of exodeviations.- IV. Surgical treatment.- IV. 1. Anaesthesia.- IV. 2. Instruments.- IV. 3. Surgical techniques.- IV. 4. Effects of surgery.- IV. 5. Indications for primary surgery.- IV. 6. Indications for secondary surgery.- V. Complications.- V.1. Limitations of duction.- V.2. Postoperative diplopia.- V.3. Changes of the antero-posterior position of the eye.- V.4. Traction on the eyelids.- Colour plates.