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Indication and Results of Pleoptics

1Zangemeister A. C., 1Gordes R.-S., 1Lewandrowski S., 2Schworm H. D., 3Haase W.,
1Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Augenheilkunde (Hamburg)
2Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Augenheilkunde, Bereich Orthoptik und Pleoptik (Hamburg)
3Augenklinik des Allgemeinen Krankenhauses Barmbek (Hamburg)

Purpose: Amblyopia is present in about 5% of children aged 5-7 years. Occlusion therapy is not always successful in children older than 4-5 years of age. Thus it seems reasonable to apply additional pleoptics in cases of late detected amblyopia.
Method: We present the results of the pleoptics in 146 patients (age ranging from 5 to 19 years, median 8 years) performed between 1976 and 1989. Out of these 146 patients 161 eyes received pleoptics additionally to occlusion therapy. This therapy primarily aimed for a change of eccentric to foveolar fixation. The improvement of visual acuity was regarded as being of secondary importance. All patients have been hospitalised for two weeks on average. The exercises were performed for two hours per day in several sessions and included Cüpper’s after images, Haidinger brushes, optomotoric stimulations and in cases of foveolar fixation monocular stimulation of fixation in free space. Fixation was examined with the ophthalmoscope and with Haidinger brushes. Visual acuity was tested with the C-test which allows to measure the visual acuity for single and line optotypes with the Landoldt-C in defined spaces between the symbols.
Results: In 29,8% of the treated eyes it was possible to change fixation from eccentric to foveolar. An improvement of visual acuity of a minimum of two lines for single and for line optotypes was observed in 52,8% and 51,2% respectively.
Conclusion: Additional pleoptics seem to be a useful tool in the treatment of late detected amblyopia. We assume that the improvement of functions may be supported by the strict control of occlusion during the hospitalisation of the patients. Ocular fixation of an amblyopic eye is the crucial parameter for the fate of this eye in the case of the loss of the better eye at an adult age.