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MEETINGS, CONFERENCES, SYMPOSIA EDITED BY THOM./
THIRD INTERNATIONAL ORTHOPTIC CONGRESS
Organized by the American Association of Certified Orthoptists and under the auspices of the International Orthoptic Association, the Third International Orthoptic Congress was held July 1-3, 1975. Boston, bathed in sunshine and at the eve of the bicentennial celebration, served as a charming hostess for this memorable event. Orthoptists and ophthalmologists from more than 20 nations participated in what turned out to be a truly outstanding program. The opening ceremony on the eve of the Congress included welcoming remarks by representatives from various orthoptic organizations and an address by Edmond Cooper who read a speech prepared by Hermann Burian before his death. Dr. Burian was to be president of honor of this Congress. After the opening ceremony, over wine and cheese, an informal get-together provided the appropriate atmosphere for greeting old friends and making new ones, an activity that makes international meetings such a pleasure to attend.
For the next three days, there followed a densely packed scientific program, covering nearly all aspects of recent advances in the diagnosis and management of strabismus. Related subjects were grouped into 13 sessions, each followed by extensive round table discussions that were skillfully moderated by strabismologists of international repute. Nearly all papers were of good quality, well presented and illustrated.
I was especially impressed by the scientific quality and excellence of presentation of those papers given by orthoptists. At a time when there is much concern among American orthoptists about becoming absorbed and perhaps replaced by other allied health personnel in ophthalmology, the contribution made by orthoptists at this Congress demonstrated clearly that orthoptics must continue in-
CHALKLEY, M.D.
dependently as an integral aspect of ophthalmology.
After the long scientific sessions, the social functions in the evenings were especially enjoyable. There was a dinner party at the New England Aquarium, where the beauty of the ladies milling in semi-darkness about a gigantic tank filled with sharks and other vicious creatures provided a rather unique contrast. The delegates also enjoyed a champagne reception at the Isabella Stewart Gardner Museum by invitation of the American and Canadian Orthoptic Associatons.
The Congress was summarized and closed by Mr. Keith Lyle, of Great Britain, after which the new chairman of the International Orthoptic Association, Miss Attie van Paas-sen, The Netherlands, was installed by the outgoing chairman, Miss Barbara N. Lee, of Great Britain. The proceedings of this Congress will be published by Symposia Specialists Medical Books.
The Fourth International Orthoptic Congress will convene in 1979 in Berne, Switzerland.
GUNTER K . VON NOORDEN
The Third International Orthoptic Congress was held in Boston, Massachusets, July 1-3, 1975. Barbara Lee, president of the International Orthoptic Association, and Evelyn Tomlihson, president of the American Association of Certified Orthoptists, presided jointly at the opening ceremony. Edmond L. Cooper gave the opening address which had been written by Hermann Burian for this occasion. The warm, personal words of welcome stressed the importance of international meetings in order that we might learn from our differences and the meeting opened with the champagne toast as Dr. Burian had wished.
The scientific sessions were interesting and provocative and the ensuing discussions especially stimulating. David H. Hubel pre-
VOL. 80, NO. 4 MEETINGS, CONFERENCES, SYMPOSIA 769
sented a paper describing the results of his work in experimental amblyopia. He showed two principal factors that caused disruption of developmental function in the visual cortex: (1) light and form deprivation at the time of high susceptibility, and (2) abnormal binocular interaction. Gunter K. von Noor-den discussed these current concepts of amblyopia. The necessity of treating amblyopia early was reinforced, but it was suggested that we refrain from using all day occlusion in a child under one year of age.
Dorothy Hedden was chairman and David Cogan was moderator for the session dealing with nystagmus. L. F. Dell'Osso presented a paper dealing with the necessity for quantitative measurements, including velocity tracings of eye movements in congenital nystagmus. After determining the null angle, he uses prisms or surgery to put the patienf s eyes at this angle. Dr. Dell'Osso contends that when the patient uses a compensatory head posture to be at this null position, he has put forth effort. which builds up the nystagmus and sacrifices visual acuity. H. Muhlendyck delivered a most controversial paper dealing with the Cuppers "Faden" operation in the treatment of convergent strabismus associated with latent nystagmus. With this procedure he changes the arc of contact of the medial rectus muscle by removing it from its insertion, placing two sutures 12 to 16 mm behind the insertion, anchoring it to the globe, and then reattaching the muscle at its original insertion.
Barbara Lee was chairman for the session dealing with prisms. Wm. Rubin, S. Veron-neau-Troutman, P. V. Berard, Aimee Be-ressi, Lynn Stockbridge, and Madame Frangoise Zamfirescu provided practical papers at this session. Prisms were reported as a safe and versatile tool in the treatment of primary exotropia, paralytic deviations, amblyopia with eccentric fixation, and as a preoperative diagnostic tool to determine the importance of a vertical component associated with esotropia.
Edward A. Dunlap was chairman and R. B. Hartcourt was moderator for the session dealing with dysthyroid eye disease, which has an unpredictable course with changes seen over a period of as long as ten years.
The treatment of strabismus in children with cerebral palsy was discussed by Judith H. Seaber. With the exception of the known variables, traditional therapy gave results comparable to those found in children without cerebral palsy. Thomas D. France reported that strabismus is the most common ocular complication of hydrocephalus, with a high incidence of an "A" pattern. He reported good results achieved with patching and surgery. Surgery was usually performed after one year. In the treatment of develop-mentally handicapped children, Diana Thorn-hill reported that functional results were not to be hoped for in many cases.
Valerie Kelly delivered a most interesting paper on ocular motor defects associated with herpes zoster ophthalmicus. The overall incidence of defects was far greater than originally reported, and some patients have demonstrated contralateral involvement.
Donelson Manley reported on superior oblique palsy and his choice of surgical procedure. Dr. Manley suggested that a graded recession of the yoke or a recession of the antagonist, after a wait of nine to 12 months, gave most satisfactory results.
R. S. Jampel and R. A. Crone reported differing opinions on the question of cyclo-fusion. Dr. Jampel stated that recent experimental work has shown cyclofusion responses are mediated by central mechanisms without any compensatory eye movements and therefore there is no motor component to cyclodeviations. Dr. Crone held with the traditional view.
The final day's scientific sessions dealt with a montage of topics. Among them was Leonard Apt's paper on the derivation of a linear equation and curve as a method of relating eye position under anesthesia to outcome of surgery. Dr. Apt showed that pa-
770 AMERICAN JOURNAL OF OPHTHALMOLOGY OCTOBER, 197S
tients with a normal amount of divergence under anesthesia had a higher rate of successful results postoperatively. G. H. Gobin reported on his results with four muscle surgery in "V" esotropia. He displaces the insertions of both inferior oblique muscles toward the equator, thus enlarging the angle between the muscle and the vertical axis. In this way he selectively reduces vertical in favor of torsional action. He believes the real barrier to fusion is the torsional dimension. To this procedure is added a bilateral medial rectus recession of at least 5 mm. Phillip Knapp reported on 50 cases of bi-medial recessions with bare scleral closure, achieving an average correction of over 40 prism diopters. W. J. Gillie's paper supported a single muscle procedure as the best choice as a reoperative procedure in convergent strabismus. Marshall M. Parks delivered a paper supporting extirpation of the inferior oblique muscle in cases of recurrent overaction. He advised this only after a careful search has been made to insure that no portion of the muscle remains attached. His choice for initial surgery is an inferior oblique recession. John S. Hermann's paper dealt with the use of anchoring sutures in the overcorrected position for a period of two weeks in strabismus patients who develop excessive and adhesive fibrosis and cannot be managed in any other manner.
The final session of the Congress concerned exotropia. Edward L. Rabb suggested that the best results were obtained when exotropic patients were overcorrected surgically, whether fusion was present or not. R. Mervyn Brown delivered a paper on consecutive exotropia. In his study early consecutive exotropia was most often caused by a medial rectus limitation, while later divergence was found attributable to amblyopia and poor binocular function. Orthoptics was generally believed to be necessary in the treatment of exotropia, although whether treatment is more beneficial pre- or postoperatively was debated.
T. K. Lyle closed the scientific sessions
with words of praise for a job well done to Joyce Mein, chairman of the Scientific Committee. Professor Lyle noted that the Congress had brought both researchers and clinicians together to share in the medical care of patients.
JANE DUNN LAVOIE
CHICAGO OPHTHALMOLOGICAL SOCIETY CLINICAL
CONFERENCE The Chicago Ophthalmological Society
held its annual Clinical Conference at the Drake Hotel, Chicago, on May 23 and 24, under the co-chairmanship of Thomas Chalk-ley and Joel A. Kaplan. J. Graham Dobbie's address of welcome was followed by a discussion of fungal keratitis by Dan B. Jones. Jorge N. Buxton spoke on glaucoma after keratoplasty.
In his paper on complications of intraocular lenses, Norman Sanders summarized the Bascom Palmer Eye Institute's five-year study of the Copeland intraocular lens. Although no comparable study of cataract cases without intraocular lenses was available, it appeared that there was a greater overall complication rate when an intraocular lens was inserted. Because of the increased risk, Dr. Sanders emphasized the need for careful consideration of each patient in whom an intraocular lens is contemplated.
Deborah Pavan-Langston spoke on the diagnosis and management of herpes simplex. The multifaceted nature of ocular herpes simplex has become more clearly defined in recent years as a disease characterized by both infectious and immune components. Therapy of infectious epithelial dendritic-geographic disease is generally gentle debridement of the ulcer followed by antimetabolite chemotherapy with IDU or adenine arabinoside. Trophic (metaherpetic) ulceration may occur after infection and is due to sterile damage of the basement membrane, which makes it difficult for the epithelium to heal across the damaged ulcer base. Therapy generally involves patching,