F
1
,Inhoud
ZVB Week C1 Werkcollege 1: het slechtziende kind .............................................................................. 7
ICD en ICF ............................................................................................................................................ 7
Jeugdgezondheid Opsporen oogafwijkingen ..................................................................................... 12
Verwerking......................................................................................................................................... 15
ZVB Week C1 Werkcollege 2: conservatieve behandelingen .............................................................. 16
Botulinumtoxine ................................................................................................................................ 16
Prisma’s.............................................................................................................................................. 24
Asthenopie ........................................................................................................................................ 28
Orthoptische oefeningen / Visuele training ...................................................................................... 28
Zenuwstelsel ...................................................................................................................................... 35
Cycloplegische medicijnen ................................................................................................................ 38
Correctie van brekingsfouten ............................................................................................................ 42
Voorschrift van een bril ..................................................................................................................... 43
Myopie........................................................................................................................................... 44
Astigmatisme ................................................................................................................................. 44
Anisometropie ............................................................................................................................... 45
ZVB Week C1 Werkcollege 3: strabismus chirurgie primaire OK ........................................................ 47
De oogspieren Innervatie .................................................................................................................. 47
Samenvatting van de oogspierfunctie ............................................................................................... 50
Strabismus chirurgie .......................................................................................................................... 51
Conjunctivale incisie ...................................................................................................................... 58
Surgical Dose tabellen ....................................................................................................................... 59
Maximale recessie of resectie ........................................................................................................... 62
Alfabet patronen management ......................................................................................................... 63
Sagittalisatie ...................................................................................................................................... 69
Sagittalisatie van de obliquus inferior (V patroon) ........................................................................ 69
Saggittalisatie van de obliquus superior (A patroon) .................................................................... 72
Witte driehoek................................................................................................................................... 74
Mindmap primaire strabismuschirurgie ............................................................................................ 76
Welke operaties kunnen aan welke spieren? .................................................................................... 77
OK aan m. rectus medialis en m. rectus lateralis.......................................................................... 77
OK aan m. rectus inferior en m. rectus superior .......................................................................... 78
OK aan m.obliquus superior .......................................................................................................... 79
OK aan m. obliquus inferior ........................................................................................................... 80
Speciale operaties en gecombineerde spieren.............................................................................. 81
2
,ZVB Week C1 Werkcollege 4: strabismus chirurgie heroperaties........................................................ 85
Limitaties van de ducties na strabismus chirurgie............................................................................. 85
Oorzaak aan kant van de limitatie ................................................................................................. 85
Oorzaak aan de andere kant van de limitatie ................................................................................ 86
Mindmap heroperaties ...................................................................................................................... 91
Casuïstiek ........................................................................................................................................... 92
ZVB Week C2 Werkcollege 1: Oculaire slechtziendheid en het slechtzienden traject, Visueel functie
onderzoek & CVI ................................................................................................................................... 96
Visueel functieonderzoek .................................................................................................................. 96
Visusniveaus en visuskaarten ............................................................................................................ 96
Cerebral Visual Impairment (CVI) ...................................................................................................... 98
Delayed Visual Maturation (DVM) ................................................................................................... 106
Congenitale stationaire nachtblindheid (CSNB) .............................................................................. 106
Albinisme ......................................................................................................................................... 107
Achromatopsie ................................................................................................................................ 107
Amaurosis congenita van Leber ...................................................................................................... 108
Usher ............................................................................................................................................... 109
Ziekte van Stargardt / Fundus Flavimaculatus ................................................................................. 109
Ziekte van Best / Vitelliforme mucla dystrofie ................................................................................ 110
ZVB Week C2 Werkcollege 2: Primaire operaties .............................................................................. 112
Bifocaal ............................................................................................................................................ 112
Intermitterende exotropie ............................................................................................................... 112
Onderzoek intermitterende exotropie ............................................................................................ 116
De rol van het vergentiesysteem bij intermitterende exotropie ..................................................... 121
Behandeling intermitterende exotropie .......................................................................................... 123
Samenvatting intermitterende XT D<V ............................................................................................ 131
Samenvatting intermitterende XT D>V ............................................................................................ 132
Differentiaal diagnose van intermitterende exotropie en decompenserende exoforie .................. 134
Infantiel scheelzien .......................................................................................................................... 135
Essentiële infantiele esotropie ........................................................................................................ 135
ELISS studie (Early vs. Late Infantile Strabismus Surgery)............................................................ 146
Infantiele exotropie ......................................................................................................................... 147
Dissociated Strabismus Complex (DSC) ........................................................................................... 148
Dissociated Vertical Deviation (DVD)............................................................................................... 148
ZVB Week C2 Werkcollege 3: Operaties incomitant scheelzien ........................................................ 158
Strabismus sursoadductorius .......................................................................................................... 158
3
, NIV parese ....................................................................................................................................... 158
Congenitale VS verworven NIV parese ............................................................................................ 160
Unilaterale VS bilaterale NIV parese................................................................................................ 162
Behandeling NIV parese .................................................................................................................. 169
NVI parese ....................................................................................................................................... 171
Verworven NIII parese ..................................................................................................................... 187
Aberante regeneratie (misdirection syndrome) .............................................................................. 203
Congenitale NIII parese ................................................................................................................... 205
ZVB Week C2 Werkcollege 4: Heroperaties........................................................................................ 206
Oorzaken van een niet succesvolle operatie ................................................................................... 206
Inter beoordelaars variabiliteit ........................................................................................................ 207
ZVB Week C4 Werkcollege 1: afwijkingen van de horizontale blik vanuit de hersenstam ............... 208
Multiple Sclerose (MS) .................................................................................................................... 208
Hersenstam structuren .................................................................................................................... 213
Internucleaire ophthalmoplegie (INO) ............................................................................................ 214
1,5 syndroom (blikparese en INO) ................................................................................................... 220
ZVB Week C4 Werkcollege 2: Oogbewegingsproblemen veroorzaakt door verschillende delen van
de hersenen ........................................................................................................................................ 222
Oogbewgingssystemen .................................................................................................................... 222
Saccasische systeem .................................................................................................................... 222
Vloeiende volgbewegingen / smooth pursuits ............................................................................ 225
Vergentie systeem ....................................................................................................................... 226
Vestibulaire en optokintische systeem ........................................................................................ 227
Dementie ......................................................................................................................................... 228
Alzheimer..................................................................................................................................... 228
Creutzfeldt-Jakob-ziekte (CJD) ..................................................................................................... 228
AIDS Dementie complex .............................................................................................................. 230
Skew deviation & oculair tilt reaction ............................................................................................. 231
Convergentie paralyse ..................................................................................................................... 234
Convergentie en accommodatie spasme / Spasm van Near Reflex (SNR) ...................................... 236
Divergentie paralyse ........................................................................................................................ 238
Age-related distance esotropia (ARDET) ......................................................................................... 240
Esotropia Associated with High Myopia (EAHM) ............................................................................ 242
Myope strabisme geassocieerd met lichte of geen significante verplaatsing van de spier ............ 242
Myope strabisme geassocieerd met aanzienlijke verplaatsing van de spier. .................................. 243
ZVB Week A4 Werkcollege 2: Introductie casuïstiek operatie indicaties .......................................... 247
4
1
,Inhoud
ZVB Week C1 Werkcollege 1: het slechtziende kind .............................................................................. 7
ICD en ICF ............................................................................................................................................ 7
Jeugdgezondheid Opsporen oogafwijkingen ..................................................................................... 12
Verwerking......................................................................................................................................... 15
ZVB Week C1 Werkcollege 2: conservatieve behandelingen .............................................................. 16
Botulinumtoxine ................................................................................................................................ 16
Prisma’s.............................................................................................................................................. 24
Asthenopie ........................................................................................................................................ 28
Orthoptische oefeningen / Visuele training ...................................................................................... 28
Zenuwstelsel ...................................................................................................................................... 35
Cycloplegische medicijnen ................................................................................................................ 38
Correctie van brekingsfouten ............................................................................................................ 42
Voorschrift van een bril ..................................................................................................................... 43
Myopie........................................................................................................................................... 44
Astigmatisme ................................................................................................................................. 44
Anisometropie ............................................................................................................................... 45
ZVB Week C1 Werkcollege 3: strabismus chirurgie primaire OK ........................................................ 47
De oogspieren Innervatie .................................................................................................................. 47
Samenvatting van de oogspierfunctie ............................................................................................... 50
Strabismus chirurgie .......................................................................................................................... 51
Conjunctivale incisie ...................................................................................................................... 58
Surgical Dose tabellen ....................................................................................................................... 59
Maximale recessie of resectie ........................................................................................................... 62
Alfabet patronen management ......................................................................................................... 63
Sagittalisatie ...................................................................................................................................... 69
Sagittalisatie van de obliquus inferior (V patroon) ........................................................................ 69
Saggittalisatie van de obliquus superior (A patroon) .................................................................... 72
Witte driehoek................................................................................................................................... 74
Mindmap primaire strabismuschirurgie ............................................................................................ 76
Welke operaties kunnen aan welke spieren? .................................................................................... 77
OK aan m. rectus medialis en m. rectus lateralis.......................................................................... 77
OK aan m. rectus inferior en m. rectus superior .......................................................................... 78
OK aan m.obliquus superior .......................................................................................................... 79
OK aan m. obliquus inferior ........................................................................................................... 80
Speciale operaties en gecombineerde spieren.............................................................................. 81
2
,ZVB Week C1 Werkcollege 4: strabismus chirurgie heroperaties........................................................ 85
Limitaties van de ducties na strabismus chirurgie............................................................................. 85
Oorzaak aan kant van de limitatie ................................................................................................. 85
Oorzaak aan de andere kant van de limitatie ................................................................................ 86
Mindmap heroperaties ...................................................................................................................... 91
Casuïstiek ........................................................................................................................................... 92
ZVB Week C2 Werkcollege 1: Oculaire slechtziendheid en het slechtzienden traject, Visueel functie
onderzoek & CVI ................................................................................................................................... 96
Visueel functieonderzoek .................................................................................................................. 96
Visusniveaus en visuskaarten ............................................................................................................ 96
Cerebral Visual Impairment (CVI) ...................................................................................................... 98
Delayed Visual Maturation (DVM) ................................................................................................... 106
Congenitale stationaire nachtblindheid (CSNB) .............................................................................. 106
Albinisme ......................................................................................................................................... 107
Achromatopsie ................................................................................................................................ 107
Amaurosis congenita van Leber ...................................................................................................... 108
Usher ............................................................................................................................................... 109
Ziekte van Stargardt / Fundus Flavimaculatus ................................................................................. 109
Ziekte van Best / Vitelliforme mucla dystrofie ................................................................................ 110
ZVB Week C2 Werkcollege 2: Primaire operaties .............................................................................. 112
Bifocaal ............................................................................................................................................ 112
Intermitterende exotropie ............................................................................................................... 112
Onderzoek intermitterende exotropie ............................................................................................ 116
De rol van het vergentiesysteem bij intermitterende exotropie ..................................................... 121
Behandeling intermitterende exotropie .......................................................................................... 123
Samenvatting intermitterende XT D<V ............................................................................................ 131
Samenvatting intermitterende XT D>V ............................................................................................ 132
Differentiaal diagnose van intermitterende exotropie en decompenserende exoforie .................. 134
Infantiel scheelzien .......................................................................................................................... 135
Essentiële infantiele esotropie ........................................................................................................ 135
ELISS studie (Early vs. Late Infantile Strabismus Surgery)............................................................ 146
Infantiele exotropie ......................................................................................................................... 147
Dissociated Strabismus Complex (DSC) ........................................................................................... 148
Dissociated Vertical Deviation (DVD)............................................................................................... 148
ZVB Week C2 Werkcollege 3: Operaties incomitant scheelzien ........................................................ 158
Strabismus sursoadductorius .......................................................................................................... 158
3
, NIV parese ....................................................................................................................................... 158
Congenitale VS verworven NIV parese ............................................................................................ 160
Unilaterale VS bilaterale NIV parese................................................................................................ 162
Behandeling NIV parese .................................................................................................................. 169
NVI parese ....................................................................................................................................... 171
Verworven NIII parese ..................................................................................................................... 187
Aberante regeneratie (misdirection syndrome) .............................................................................. 203
Congenitale NIII parese ................................................................................................................... 205
ZVB Week C2 Werkcollege 4: Heroperaties........................................................................................ 206
Oorzaken van een niet succesvolle operatie ................................................................................... 206
Inter beoordelaars variabiliteit ........................................................................................................ 207
ZVB Week C4 Werkcollege 1: afwijkingen van de horizontale blik vanuit de hersenstam ............... 208
Multiple Sclerose (MS) .................................................................................................................... 208
Hersenstam structuren .................................................................................................................... 213
Internucleaire ophthalmoplegie (INO) ............................................................................................ 214
1,5 syndroom (blikparese en INO) ................................................................................................... 220
ZVB Week C4 Werkcollege 2: Oogbewegingsproblemen veroorzaakt door verschillende delen van
de hersenen ........................................................................................................................................ 222
Oogbewgingssystemen .................................................................................................................... 222
Saccasische systeem .................................................................................................................... 222
Vloeiende volgbewegingen / smooth pursuits ............................................................................ 225
Vergentie systeem ....................................................................................................................... 226
Vestibulaire en optokintische systeem ........................................................................................ 227
Dementie ......................................................................................................................................... 228
Alzheimer..................................................................................................................................... 228
Creutzfeldt-Jakob-ziekte (CJD) ..................................................................................................... 228
AIDS Dementie complex .............................................................................................................. 230
Skew deviation & oculair tilt reaction ............................................................................................. 231
Convergentie paralyse ..................................................................................................................... 234
Convergentie en accommodatie spasme / Spasm van Near Reflex (SNR) ...................................... 236
Divergentie paralyse ........................................................................................................................ 238
Age-related distance esotropia (ARDET) ......................................................................................... 240
Esotropia Associated with High Myopia (EAHM) ............................................................................ 242
Myope strabisme geassocieerd met lichte of geen significante verplaatsing van de spier ............ 242
Myope strabisme geassocieerd met aanzienlijke verplaatsing van de spier. .................................. 243
ZVB Week A4 Werkcollege 2: Introductie casuïstiek operatie indicaties .......................................... 247
4
