Binocular vision & strabismus quarterly
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Binocul Vis Strabismus Q · Jan 2004
Comparative StudyThe profound augmentation of the oculocardiac reflex by fast acting opioids.
Trigemino-vagal bradycardia elicited by tension on an extraocular muscles (oculocardiac reflex; OCR) is a hazard for strabismus surgery patients. OCR can be reduced by anticholinergic medications and regulating the depth of anesthesia. We investigated the influence of narcotic agents as a routine part of general anesthesia for strabismus surgery in adults and children. ⋯ In the absence of anticholinergic blockade, rapidly acting narcotics enhance the degree of bradycardia due to the OCR elicited by controlled extraocular muscle tension during strabismus surgery. Some opioids had the same augmenting magnitude as the blocking effect of IV anticholinergic medication. Meperidine, which has some anticholinergic characteristics, neither blocked nor augmented the OCR.
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Binocul Vis Strabismus Q · Jan 2003
Clinical Trial Controlled Clinical TrialThe effect of induced muscle tension and fatigue on the oculocardiac reflex.
We investigated surgeon-modified factors in the oculocardiac reflex (OCR) including repeating tension after return to baseline pulse (fatigue) or modifying the tension place on the extraocular muscle (EOM). ⋯ A surgeon can reduce oculocardiac reflex by exerting very gentle 50 gram tension on the EOM or waiting for return to baseline heart rate before fatiguing the reflex. These reductions are of less clinical value than pharmacologic intervention.
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Binocul Vis Strabismus Q · Jan 2003
Case ReportsAcute esotropia in heroin withdrawal: a case series.
Esotropia during opiate withdrawal is a new clinical syndrome that has only recently been reported in the literature. ⋯ The precise cause of esotropia with heroin withdrawal is uncertain. Most (and possibly all) of these patients have one or more objective strabismogenic features, and these are probably a large factor in the causation.
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Binocul Vis Strabismus Q · Jan 2002
Comparative StudyEvaluation of surgical intervention in familial isolated simple ectopia lentis: younger v. older generations.
There continues to be a debate whether surgical management of ectopia lentis in children is an appropriate course to improve visual acuity and prevent further amblyopia over medical and optical management. The long term outcome and postoperative status of three generations of patients in a single family with simple ectopia lentis is presented. ⋯ For the younger generations of this family, surgical intervention for simple ectopia lentis provided improvement in visual acuity. Without surgery, amblyopia may have occurred in one or both eyes. For the oldest generation of this family, glaucoma and poor vision was the end result. Hopefully, the earlier treatment of the ectopia lentis in these children will result in better vision now and in the long term.
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Binocul Vis Strabismus Q · Jan 2002
Randomized Controlled Trial Clinical TrialThe attenuating effect of intraglossal atropine on the oculocardiac reflex.
Bradycardia during strabismus surgery is reduced better by intravenous than by intramuscular (deltoid) anticholinergics, but recent studies suggest that injection into the tongue works faster than into the deltoid. We sought to study this using the suppression of the oculocardiac reflex during eye surgery as a parameter. ⋯ Intraglossal atropine is an effective alternative for oculocardiac reflex prophylaxis when intravenous access is not readily available in strabismus surgery. The intraglossal route is in fact slightly more effective in this regard that the intravenous route per se.