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Casuistiek samenvatting blok B
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Samenvatting van alle onderwerpen besproken tijdens de lessen van casuïstiek blok B.
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InhoudsopgaveOperatievoorstellen....................................................................................................................................... 4
Soorten operaties.................................................................................................................................................4
Anteropositie........................................................................................................................................................4
Faden procedure (posterior fixation suture)........................................................................................................4
Harada-ito............................................................................................................................................................4
Sensoriek wel of niet opereren.............................................................................................................................5
Herhaling operaties blok A............................................................................................................................. 6
Operatie indicaties...............................................................................................................................................6
Factoren de operatie beïnvloeden........................................................................................................................6
Vooronderzoek operaties.....................................................................................................................................7
Soorten operaties.................................................................................................................................................7
Manieren om de conjunctiva te openen.........................................................................................................7
Versterken (versterken van de actie)..............................................................................................................7
Verzwakking (vermindering van de actie).......................................................................................................8
Transponeren (de richting van actie veranderen)...........................................................................................8
A/V-patroon.....................................................................................................................................................9
POOS...................................................................................................................................................................11
Voor en nadelen vroeg/laat opereren................................................................................................................13
Operatievoorstel.................................................................................................................................................13
Overig operaties.................................................................................................................................................15
Complicaties na operaties............................................................................................................................ 17
Chemosis............................................................................................................................................................17
Conjunctivale cyste.............................................................................................................................................17
Endophthalmitis.................................................................................................................................................18
Granuloom rond de hechting.............................................................................................................................19
Losgeschoten spier.............................................................................................................................................19
Ischemie..............................................................................................................................................................20
Naaldperforatie..................................................................................................................................................20
Orbitale cellulitis.................................................................................................................................................21
Ooglidretractie...................................................................................................................................................21
Pupil dilatatie.....................................................................................................................................................21
Phthisis bulbi......................................................................................................................................................21
Pyogeen granuloom...........................................................................................................................................21
Refractieafwijking..............................................................................................................................................21
Overig operaties.................................................................................................................................................21
Fixatie disperatie......................................................................................................................................... 23
Fixatie disperatie................................................................................................................................................23
1
, Asthenope klachten............................................................................................................................................23
Motiliteitsproblemen................................................................................................................................... 24
Elevatie beperking met ptosis............................................................................................................................24
Double elevator palsy....................................................................................................................................24
Brown’s syndroom.........................................................................................................................................24
Geïsoleerde inferior oblique palsy.................................................................................................................24
Trapped superior oblique tendon.................................................................................................................25
NIV-parese.....................................................................................................................................................25
Sagittalisatie M. obliquus inferior..................................................................................................................26
Blow out fractuur orbita................................................................................................................................26
Congenital Fibrosis of the Extraocular Muscles (CFEOM)..................................................................................26
Syndroom van Duane.........................................................................................................................................26
Neuro casuïstiek.......................................................................................................................................... 27
Oculomotore apraxie.........................................................................................................................................27
NIII-parese..........................................................................................................................................................27
Myasthenia Gravis.............................................................................................................................................28
Skew Deviation...................................................................................................................................................29
Internucleaire Opthalmoplegie (INO).................................................................................................................30
Down syndroom.......................................................................................................................................... 31
Pathologie................................................................................................................................................... 32
Coloboom...........................................................................................................................................................32
Congenitaal cataract..........................................................................................................................................32
Kerncataract bij een baby..............................................................................................................................33
Ectopie van de macula.......................................................................................................................................33
Hemangioom......................................................................................................................................................34
Exopthalmus.......................................................................................................................................................35
Afwisselende Exopthalmus............................................................................................................................36
Glaucoom bij kinderen.......................................................................................................................................37
Graves orbitopathie...........................................................................................................................................37
Hypoplasie van de oogzenuw.............................................................................................................................38
Hydrocephalus....................................................................................................................................................38
Keratoconus.......................................................................................................................................................38
Leukocorie..........................................................................................................................................................39
Micropthalmos...................................................................................................................................................39
Lensafwijkingen bij ziektes en syndromen.........................................................................................................39
Proptosis.............................................................................................................................................................40
Orbitale cellulitis............................................................................................................................................40
Lymfangioom.................................................................................................................................................40
Conjunctivitis.................................................................................................................................................40
Dermoidcysten...............................................................................................................................................41
Persistent Fetal Vasculature (PFV).....................................................................................................................41
2
, M. Coats.............................................................................................................................................................42
Ooglidafwijkingen..............................................................................................................................................42
Opticus glioom...................................................................................................................................................42
Ptosis..................................................................................................................................................................43
Retinoblastoom..................................................................................................................................................43
Testen bij pathologie..........................................................................................................................................45
Overig pathologie...............................................................................................................................................45
Genetica...................................................................................................................................................... 47
Overig.......................................................................................................................................................... 54
Declaratie zorg...................................................................................................................................................54
Kinderen die “vreemde dingen zien”..................................................................................................................54
Charles Bonnet syndroom.............................................................................................................................54
Alice in wonderland syndroom......................................................................................................................54
Overige aantekeningen................................................................................................................................ 56
Amblyopie...........................................................................................................................................................56
Occlusie bij dbb..................................................................................................................................................56
Begrippen.................................................................................................................................................... 58
3
, Operatievoorstellen
Soorten operaties
Anteropositie
Anteropositie zorgt voor correctie van de hoogte, niet van de cyclo. Wordt gedaan bij
patronen.
Faden procedure (posterior fixation suture)
Verzwakkende operatie op de contralaterale synergist van een paretische spier. Zorgt voor
verminderde trekkracht in de werkingsrichting van de spier, soort remhechting.
Indicaties
- M. rectus lateralis parese
- Accommodatief strabismus met CE
- Infantiele esotropie met torticollis
- DVD
- NBS
FADEN wordt weinig gedaan in verband met vergroeiing.
Harada-ito
Doel van de operatie is het weghalen van de cyclotropie zonder invloed te hebben op de
verticale en horizontale deviatie.
Indicatie voor een harada-ito is als er klachten zijn van cyclotorsie zonder een verticale of
horizontale deviatie
Harada ito werkt alleen op de cyclo werking.
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