Squint Surgery Prasad Walimbe
INDEX
ABCDEFGHIJKLMNOPQRSTVW
A
Actions of extraocular muscles 25
Active
force generation test 145
thyroid orbitopathy 181
Adherence syndrome 208
Adult refractive strabismus 235
Advances in orbit anatomy 218
Allen cards 40
Alleviate diplopia 144
Amyotrophic lateral sclerosis 180
Anesthesia 91
for squint surgery 3
Anesthetic challenges in squint surgery 10
Aniseikonia 163
Anisometropia 163
Anterior
ciliary blood vesels 33
segment ischemia 207
A-pattern strabismus 136
Assessment of infant vision 222
Atropine 8
B
Bagolini’s
glasses 45, 48
striated glasses 45
Barbie retractors 78, 79
Bilateral
myopia and esotropia 166
symmetrical surgery 86
Binocular motor functions 49
Blood supply 32
Blow out fracture 144
Botulinum toxin 180, 230
BP handle 80
Breakdown infusion 163
Brown’s syndrome 49, 66, 136, 139, 144, 158
Bruckner test 50
Bull dog clamps 78
C
Capturing muscle 132
Caruncle 21
Castroviejo caliper 75
Central fusion disruption 145
Chavassee hook 79
Choice of anesthesia 7
Ciliary vessel-sparing surgery 246
Clostridium botulinum 178
Combined recess-resect
procedure 146
Compensatory head posture 48
Complications in squint surgery 195
Computer modeling of
strabismus 220
Computerized tomography 227
Congenital fibrosis syndrome 144
Conjunctiva 20, 198, 208
Conjunctival
closure 105
incision 100
Consecutive strabismus 184
Corneal light reflex tests 49
Counseling for squint surgery 63
Cover tests 49, 50
Cranial nerve palsies 181
Curved locking fixation forceps 80
Cyclic esotropia 181
Cycloplegic refraction 36, 60, 61
D
Dellen formation 209
Desflurane 8
Diplopia charting 144
Direct trauma 163
Disinsertion 163
Dissimilar
image tests 49, 53
target tests 49, 56
Dissociated vertical deviation 127, 183
Disturbance of binocular vision 209
Double Maddox rod test 54, 55
Duane’s syndrome 144
Dysthyroid ophthalmopathy 144
E
E chart 41
Eaton-Lambert syndrome 180
Epithelial damage 209
Esotropia 65, 184
Exotropia 65, 185
Explaining type of squint 64
Exposure of muscle 101
with fornix incision 106
Extraocular
movement charting 58
muscle insertions 26, 196
Eye
movement recording 224
muscle surgery 238
F
Faden
operation 106
suture
with recession 107
without recession 107
Fat pad 21
Faulty muscle isolation 196
Field of binocular vision 59
Fixation
forceps 76, 77
pattern 37
Forced
duction test 9, 58, 145
generation test 59, 60
Foster’s augmentation 147
of transposition 148
Four-step test 225
Free tenotomies 106
Frisby test 43, 44
Full tendon transposition 147
Fundus examination 36, 62
Fusion with underlying structures 21
G
General anesthesia 8
H
Half bow tie method 170
Halothane 8
Harley’s classification 160
Head posture 48
Heavy eye syndrome 167
Hemorrhage 198
Hess’
charting 145
screening 56
Heterotropia 162
Hirschberg’s test 49, 50
Horizontal
muscle surgery for strabismus 99
rectus muscles 26
strabismus 184
Hypertropia 65
I
Indications for surgery 131
Infantile strabismus syndrome 216
Inferior
oblique 29
muscle 30, 197, 292
palsy 136
weakening procedures 129
rectus 28, 127
Instruments for strabismus surgery 73, 81
Intermuscular septa 115
Intraocular pressure 10
Isoflurane 8
J
Jameson muscle hooks 79
K
Ketamine 8
L
Lancaster red/green test 57
Lang’s test 43, 44
Laryngeal mask airway 9
Lateral rectus 27
resection 146
Lea’s symbols 41
Light source 80
Limbal
fusion of conjunctiva and anterior Tenon’s 22
incision made with Wescott scissors 112
Local anesthesia 12
M
Macular ectopia/gliosis 163
Maddox rod 54
Major amblyoscope 46, 57
Malignant hyperthermia 210
Measurement of deviation 47
Medial rectus 26
recession 146
Modified
Krimsky’s test 50, 51
muscle hooks 77
Moebius syndrome 144, 160
Monocular elevation deficit 127
Mosquito clamps 80
Motor
neuropathy 180
testing 48
Muscle 20, 25
anchored to sclera with locking knots 117
clamps 78, 79
disinsertion 201
hooks 74
ischemia 163
retraction 202
secured to insertion 124
slip 163
surgery 88
vessels 199
Myasthenia gravis 180
Myectomy 133
Myotomy 132
N
Nausea and vomiting 11
Near stereoacuity 43
Needle
holder 75, 76
tract lesion 202
Nerve damage 163
Neuromuscular junction disorders 180
Nondepolarizing muscle relaxants 8
Nonresolving paralytic strabismus 144
Nystagmus 183
surgery 246
O
Oblique muscle 29
surgery 129
pulleys 219
structure 218
Oculocardiac reflex 10
Ophthalmoplegia 184
Opioids 8
Optional instruments 77
Optokinetic nystagmus 38
Orbital fracture 165
Overlying scleral layer 201
P
Palpebral fissure 20
Paradoxical diplopia 183
Paralytic strabismus 181
Partial
paralysis 146
tendon transposition 147
third nerve palsy 149
Peribulbar anesthesia 12, 14
Peripheral motor neuron disease 180
Plica semilunaris 21
Position of lids 49
Postanesthetic nausea and vomiting 210
Posterior
fixation suture 156
tenectomy of superior oblique 137
Postoperative
adjustment of sutures 171, 174
consecutive strabismus 181
diplopia 209
drug regime 193
nausea and vomiting 9
pain 11
Postscleral buckling 144
Preferential looking tests 39, 40
Pregnancy 180
Previous multiple surgeries 181
Principles of strabismus surgery 83
Prism bar cover test 52
Propofol 8, 9
Pulled-in two syndrome 204
Pulse oximeter 81
Q
Quantification 130
R
Randot stereograms 43, 44
Recession 103, 134
Recognition acuity 40, 41
Red filter test 54
Redundant muscle tissue 123
Refractive surgery 235
in children 236
Relaxing incision 113
Restrictive strabismus 144, 154
Retrobulbar anesthesia 12, 13
S
Saccadic velocity 59
Sclera 20, 32
Sensory
strabismus 183
tests 43
Sevoflurane 8
Sheridan-Gardiner test 42
Single muscle surgery 87
Sliding noose method 172
Slipped muscle 203
Speculum 80
Spiral of tilaux 29
Strabismology surgery 74
Strabismus 221
in high myopia 144, 166
Subconjunctival cysts 208
Sub-Tenon’s anesthesia 12, 15
Superior
oblique
muscle surgery 243
procedures 136
tendon 31, 150, 198
tuck 141
rectus 28, 127
Surgery after
blowout fracture 164
scleral buckling
procedure 162
Surgery for
Duane syndrome 243
fourth nerve palsy 152
incomitant strabismus 240
paralytic strabismus 238
Surgery in
Brown’s syndrome 158
congenital fibrosis
syndrome 160
Duane’s syndrome 154
fourth nerve palsy 152
Moebius syndrome 159
sixth nerve palsy 146
third nerve palsy 149, 151
thyroid ophthalmopathy 161
Surgical points 26–29
Suture
granuloma 206, 207
tying forceps 76, 77
Suxamethonium 8
Synoptophore 46
T
Technique of injection 179
Telemedicine 229
Teller acuity cards 38
Tenectomy 136
Tenon’s capsule 20, 22
Tenotomy 136
Tests for
stereopsis 43
suppression 43, 46
Thiopentone 8
Thyroid ophthalmopathy 162
Timing of surgery in infantile strabismus 237
Titmus stereo test 43, 44
Topical anesthesia 12, 16
Total
paralysis 146
third nerve paralysis 149
Traditional methods 231
Treatment of amblyopia 231
V
Various surgical strategies 149
Vertical
and oblique muscle surgery 125
rectus
muscles 28
recession 127
strabismus 182
Visual acuity 37
in nystagmus 42
Visually evoked potential 39
Von Graefe hook slides 114
Vortex veins 199
W
Weakening procedures 106
Westcott’s scissors 75, 76
Worth 4 dot test 47
×
Chapter Notes

Save Clear

1STEP BY STEP® SQUINT SURGERY
3STEP BY STEP® SQUINT SURGERY
Editor Prasad Walimbe MS DNB FAEH FPO (USA) Pediatric Ophthalmologist and Squint Specialist Consultant Jehangir Hospital and Deenanath Mangeshkar Hospital Pune, Maharashtra, India Walimbe Eye Clinic Aranyeshwar Park, Sahakarnagar Pune, Maharashtra, India Foreword Burton J Kushner
4Published by
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India
Phone: +91-11-43574357, Fax: +91-11-43574314
Offices in India
Overseas Offices
Step by Step® Squint Surgery
© 2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication and DVD ROM should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editor will not be held responsible for any inadvertent error (s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 2011
9789350251966
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
5Dedicated to
Department of Pediatric Ophthalmology and Strabismus Aravind Eye Hospital Madurai, Tamil Nadu, India
Where the mind is without fear and the head is held high;
Where knowledge is free;
Where the world has not been broken up into fragments
by narrow domestic walls;
Where words come out from the depth of truth;
Where tireless striving stretches its arms towards perfection;
Where the clear stream of reason has not lost its way
into the dreary desert of dead habit;
Where the mind is led forward by thee into ever widening thought and action,
Into that heaven of freedom, my father let my country awake.
Rabindranath Tagore
(Gitanjali)
6
7CONTRIBUTORS 11FOREWORD
This book, Step by Step Squint Surgery, edited by Dr Prasad Walimbe is a real jewel. As the title suggests, it provides a step-by-step approach to the common and not so common problems one encounters in the surgical management of patients with strabismus. It is straightforward, practical, full of useful pearls, and easy-to-read. Nestled between the front and back covers, in orderly fashion, are chapters dealing with the preoperative, intraoperative, and postoperative challenges the strabismus surgeons face. I think it belongs in a readily accessible spot on the bookshelf of the strabismus specialists, ophthalmology residents, and every comprehensive ophthalmologist who has the opportunity to treat strabismus surgically. They will certainly want to consult it frequently. I congratulate the authors on this worthwhile publication.
Burton J Kushner md
John W and Helen Doolittle Professor
Director, Pediatric Ophthalmology and Adult Strabismus
Department of Ophthalmology and Visual Sciences
University of Wisconsin Madison, WI, USA
12
13PREFACE
The history of medicine in ancient times goes back to remote antiquity—somewhere between 4000 and 900 BC., The period between the seventh and first century BC saw an immense change in thinking process across the ancient world: Greece, China, Mesopotamia and India. In each of these widely separated centers of civilization, there was evidence of an advance in speculative thought of medicine. Since then, the world has seen sea changes in the field of medicine with its new branches, superspecialties, drugs, techniques, surgeries, philosophies and research.
The history of modern squint surgery starts from the end of eighteenth century. The first surgical trials consisted of performing myotomies of medial rectus. By the end of nineteenth century, surgical treatment of exodeviations was established. During twentieth century, progress achieved in anesthesiology, quality of suture materials and other techniques; further refined the squint surgery. Over the past decade, there has been a rapid evolution and advances in all ophthalmic superspecialties including strabismology.
Despite the easy availability of extensive resources online to the ophthalmologists, accessing this ocean of information can be time-consuming and often confusing. Given the complexity and quantity of clinical knowledge required to correctly identify and surgically treat ocular motility disorders, a quick and practical reference book with step-by-step explanation of various techniques of squint surgery represents an invaluable resource to the busy general ophthalmologists as well as postgraduate students. 14There are very few quality books which teach us practically how to do the basic steps in strabismus surgery. I feel this book will fill that void.
The purpose of this book is to present basic principles and technique of squint surgery in a step-by-step and easy-to-understand manner.
The squint surgery is a combination of dexterity, knowledge, judgment and experience which is gleaned over many years of practice. In this book, the stalwarts in strabismology have privileged us with their experience, which is definitely carried over in the contents of this excellent guide.
Theoretical learning of squint surgery must always be supported by a positive practical training and this book aims to help in giving that guidance. This book is written in a clear, logical and structured format with many illustrations, diagrams, photographs and is also coupled with high quality surgical video footage.
This book is divided into four sections, viz. preoperative considerations, preferred surgical techniques, postoperative considerations and recent advances; in which highly regarded and expert strabismologists have presented their strategic thinking in this field and described the nuances of squint surgery in a simple yet very effective, step-by-step and lucid approach.
I have been privileged to have the opportunity of first-hand studying all the thoughtful chapters from distinguished faculties in strabismology and I envy myself for that. I have gone through several proofreadings, debated on scientific layout of manuscripts and finally receiving, an eagerly awaited scholarly gift—the final printed version of Step by Step Squint Surgery—the labor has been very satisfying!15
I sincerely hope that this book befriends your bookshelf and serves as a ready reckoner for general ophthal-mologists, orthoptists, optometrists, residents in ophthal-mology and squint specialists alike.
I also hope, the coming decade ushers in symbiotic advances in all specialties of medicine including ophthalmology and especially strabismology, where ophthalmologists will work for unity, achieve fusion and create a third dimension in spite of two disparate views—not only for the eyes but for the society as a whole!
Any suggestions from readers regarding any matter they believe could improve our future editions are welcomed.
Prasad Walimbe
 
 
References
  1. Muthu C. A Short Review of the History of Ancient Hindu Medicine. Proc R Soc Med 1913;1:177.
  1. Sarma PJ. Hindu Medicine and its Antiquity. Ann Med Hist 1931;3:318.
  1. Royale JF. An Essay on the Antiquity of Hindu Medicine. Wiliam H Allen & Co,  London,  1837.
  1. Thorwald J. Science and Secrets of Early Medicine. Harcourt, Brace & World Inc.  New York,  1963 p 194.
  1. Remy C, Aracil P. History of Strabismus Surgery. J Fr Ophthalmol 1984;7(6–7):493–8.16
17ACKNOWLEDGMENTS
This book is the result of tremendous efforts of all authors, who are doyens in the field of strabismology and who dedicated their precious time for this endeavor. I am greatly indebted to all of them.
The authors' royalty from the sale of this book goes to Poor Children Spectacle Fund, Department of Pediatric Ophthalmology and Strabismus; Aravind Eye Hospital, Madurai, Tamil Nadu, India.
I would like to acknowledge all respected authors: Dr P Vijayalakshmi, Dr Stephen P Kraft, Dr Kalpana Narendran, Dr Sumita Agarkar, Dr A Ravichandar, Dr Milind Killedar, Dr Arun Samprathi, Dr Mihir Kothari and Dr Ramesh Murthy; who kindly consented not to take their author's remuneration for this noble cause.
I specially thank Dr Stephen P Kraft, Dr P Vijayalakshmi and Dr Kalpana Narendran, who in spite of their busy schedules, submitted their chapters before deadline.
I am immensely grateful to my teacher Dr P Vijayalakshmi, who considered me worthy for this job.
I express my heartfelt gratitude to my teacher Dr Burton J Kushner, who always encourages and supports me in all my ventures in this field.
I gratefully acknowledge M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India and especially Mr Ramesh (Mumbai Branch) for their cooperation in the entire project.
I also wish to thank my wife Dr Tejaswini, my children Atharva and Ramaa and my parents for their continuing support.