'Capable of being in uncertainties': applied medical humanities in undergraduate medical education.

Numerous medical schools have been updating and modernising their undergraduate curricula in response to the changing health needs of today's society and the updated General Medical Council competencies required for qualification. The humanities are sometimes seen as a way of addressing both of these requirements. Medical humanities advocates would argue that the humanities have a vital role to play in undergraduate medical education, allowing students to develop the critical tools required by the 21st-century clinician to deliver the best person-centred care.

Ophthalmic Evaluation in Beta-Thalassemia.

Objectives: To determine the association of ocular manifestations in beta-thalassemia with the patient's age, blood transfusion requirements, average serum ferritin and dose and duration of iron chelation therapy.

Methods: Sixty multi-transfused beta thalassemia patients of 12 to 18 y of age on chelation therapy were included in this cross-sectional analysis. Structural and functional evaluation of the retina was done using Optical coherence tomography (OCT) and Electroretinography (ERG), including flash ERG and Pattern ERG (PERG).

Surgical results of patients with unilateral superior oblique palsy presenting with large hypertropias.

Purpose: Surgical management of superior oblique palsy (SOP) is challenging because of combined vertical, horizontal, and torsional misalignment. The authors report the surgical results of patients with large primary position hypertropias (> 20 prism diopters [PD]) due to unilateral SOP.

Methods: Criteria for success included correction of the anomalous head posture, primary position alignment between orthotropia and 6 PD of undercorrection, and no reoperation required for residual deviations in any direction of gaze.

Augmented bilateral lateral rectus recessions in basic intermittent exotropia.

Purpose: To compare the outcomes of conventional surgery with the outcomes of surgeries using augmented amounts of symmetric lateral rectus recessions in the treatment of patients with basic intermittent exotropia.

Methods: One hundred seven patients were enrolled in this study; the patients were followed for more than 6 months. The study group was composed of 41 patients who had undergone conventional surgery, and 66 who had augmented surgery.

Maximum motor fusion combined with one-hour preoperative prism adaptation test in patients with acquired esotropia.

Purpose: Preoperative prism adaptation and the maximum motor fusion test reduce the risk of postoperative undercorrection, overcorrection, and bifocal requirements in acquired esotropia. The purpose of our study is to determine the efficacy of the maximum motor fusion test followed by a short prism adaptation test in patients with acquired esotropia undergoing bilateral medial rectus muscle recession.

Methods: We undertook a retrospective review of 29 subjects with acquired esotropia without history of amblyopia, previous strabismus surgery, use of bifocals, pattern anisotropia, dissociated vertical deviation, or oblique muscle dysfunction.

Superior oblique posterior tenectomy in patients with Brown syndrome with small deviations in the primary position.

Introduction: Procedures used to weaken the superior oblique muscle (SO) tendon in the treatment of patients with Brown syndrome, may result in severe complications, including complete SO palsy, overcorrections, foreign body extrusion, and scarring with limitation to ocular rotations. SO posterior tenectomy moderately weakens abduction and depression while preserving most of the torsional action of the SO muscle.

Purpose: We sought to evaluate motor and sensorial results after SO posterior tenectomy in patients with Brown syndrome who had a small vertical deviation (less than 7 prism diopters [PD]) in primary position but severe limitation to elevation in adduction.

High-resolution magnetic resonance imaging demonstrates abnormalities of motor nerves and extraocular muscles in patients with neuropathic strabismus.

Introduction: Although the ocular motility examination has been used traditionally in the diagnosis of strabismus that is a result of cranial nerve (CN) abnormalities, magnetic resonance imaging (MRI) now permits the direct imaging of lesions in CN palsies.

Methods: Prospectively, nerves to extraocular muscles (EOMs) were imaged with T1 weighting in orbits of 83 orthotropic volunteers and 96 strabismic patients in quasicoronal planes using surface coils. Intraorbital resolution was 234-312 microns within 1.

Extensive persistent pupillary membranes: conservative management.

Extensive persistent pupillary membranes (PPMS) may appear to occlude the pupil so completely as to preclude useful vision. They often motivate aggressive interventions. We present a 6-year-old girl with bilateral extensive densely pigmented pupillary membranes in whom good vision was obtained without pharmacologic, laser, or surgical intervention.

Extraocular muscle damage associated with endoscopic sinus surgery: an ophthalmology perspective.

Background: Orbital complications associated with endoscopic sinus surgery are well documented. Damage to the medial rectus muscle results in complicated strabismus and disturbing diplopia. The aim of this study was to characterize the types of extraocular muscle injury and the number of muscles involved that may complicate endoscopic sinus surgery and correlate its occurrence to factors in the surgical procedure itself.

Chorioretinitis as a complication of pauciarticular juvenile rheumatoid arthritis.

A girl with pauciarticular juvenile rheumatoid arthritis developed bilateral uveitis complicated by cataract and glaucoma. Sequential fundus photography documented development of extensive choroidal scarring and retinal pigment epithelial atrophy in the left macula. Vision was not impaired.

Superior oblique muscle involvement in thyroid ophthalmopathy.

Background: Rectus muscle involvement in thyroid ophthalmopathy is well documented. The inferior rectus is the most frequently involved, followed by the medial, superior, and infrequently the lateral rectus. This study reports involvement of the superior oblique muscle as a contributory cause of restrictive strabismus in patients with thyroid ophthalmopathy.

Combined adjustable rectus muscle resection--recession for incomitant strabismus.

Introduction: We sought to report the results of combined adjustable suture resection and recession of a rectus extraocular muscle in a subset of patients who are asymptomatic in the primary position but diplopic in secondary functional gaze positions.

Methods: We undertook a retrospective chart review of 12 patients who underwent a surgical procedure consisting of combined resection and recession of the same rectus extraocular muscle on adjustable suture, the amount of recession being double the amount of resection.

Results: The amount of incomitance reduced from a preoperative mean of 11.

Lateral rectus resections in divergence palsy: results of long-term follow-up.

Introduction: Lateral rectus resections have been previously advocated as surgical options to treat patients with divergence palsy who do not respond well to prisms. This study was undertaken to review the results and long-term follow-up of patients with divergence palsy who underwent lateral rectus resections at our institution.

Methods: Retrospective review of 29 patients (age 35-83 years) with divergence palsy.

Strabismic complications following endoscopic sinus surgery: diagnosis and surgical management.

Introduction: Endoscopic surgical techniques improve the surgeon's view of sinus structures but are subject to extraocular muscle complications that cause permanent diplopia.

Methods: A series of 15 patients with strabismus following endoscopic sinus surgery was reviewed retrospectively to characterize the type of muscle injury and report the results of surgical correction.

Results: A variety of insults to the medial rectus (MR) muscle occurred, ranging from contusion, hematoma, oculomotor nerve damage with paralysis, muscle transection, and muscle destruction.

Rectus muscle orbital wall fixation: a reversible profound weakening procedure.

Introduction: Surgical treatment of third nerve palsy, sensory exotropia and strabismus secondary to anomalous innervation of the rectus muscles, frequently require large rectus muscle recessions in an attempt to maintain alignment in the primary position and reduce the effects of misinnervation. The aim of this study was to describe and evaluate the results of inactivation of a rectus muscle by its attachment to the adjacent orbital wall.

Methods: Seven subjects diagnosed with third-nerve palsy (three cases), Duane syndrome (two cases), sensory exotropia (one case), and congenital aberrant innervation of vertical rectus muscles (one case) underwent rectus muscle inactivation by orbital wall fixation.

Surgical management of severe cocontraction, globe retraction, and pseudo-ptosis in Duane syndrome.

Background: Correction of severe cocontraction and pseudo-ptosis present unique surgical challenges in patients with Duane syndrome.

Methods: We report four Duane syndrome patients with esotropia in primary position, poor abduction, and severe cocontraction causing limitation to adduction, globe retraction, and pseudo-ptosis. All were treated with partial tendon transposition of the vertical rectus muscles augmented with Foster fixation sutures and surgical weakening of the ipsilateral lateral rectus muscle.

Partial rectus muscle-augmented transpositions in abduction deficiency.

Purpose: Lateral posterior fixation sutures increase the effect of full rectus extraocular muscle transpositions. Partial rectus muscle transposition may be indicated to minimize the risk of anterior ischemia when multiple rectus muscles require surgery to achieve ocular alignment.

Purpose: To report a modification of full vertical rectus muscle transposition with lateral posterior fixation sutures for use in patients at risk for anterior segment ischemia.

Acquired strabismus following cosmetic blepharoplasty.

The purpose of this study was to report on 12 patients with acquired strabismus following cosmetic blepharoplasty and to identify patterns of strabismus related to the surgical procedure. Clinical ophthalmologic examinations were performed to specifically clarify the type of strabismus. Operative reports of the blepharoplasty procedures were reviewed.