The Effect of Jensen Procedure with Medial Rectus Recession in Lateral Rectus Palsy

Jensen procedures with medial rectus recession were performed on 13 eyes of 10 patients with lateral rectus palsy caused by trauma. The cases were reviewed retrospectively to assess efficacy of the procedure and long-term stability. After the average 10.2 months of follow-up period, the 7 patients on whom unilateral Jensen procedures and medial rectus muscle recession were performed improved an average of 45.0 delta, and the 3 patients who underwent bilateral Jensen procedures and medial rectus muscle recession improved an average of 82.3 delta. Preoperatively, 12 eyses demonstrated abduction of -4, and 1 eye demonstrated abduction of -1. Postoperatively, abductions of eyes are as follows: 3 eyes -4, 5 eyes -3, 3 eyes -2, and 2 eyes -1. 10 eyes (76.9%) showed improved abduction of lateral rectus muscle, but 3 eyes(23.1%) were not changed. 4 patients(40.0%) acquired a functional area of diplopia free vision, but 6 patients(60.0%) did not, 1 patient developed diplopia postoperatively. No significant cases of vertical deviation were created. One showed anterior segment ischemia, but recovered without complications. Based on these results, the Jensen procedure combined with medial rectus recession is effective in correcting palsies of the lateral rectus muscle that is not recovered.

Ultrasonographic Study of Glaucoma Implant

The fibrovascular tissues surrounding a glaucoma implant have been found to play a major role for the orbital absorption of aqueous humor following a glaucoma implant surgery. An ultrasonographic study was performed to investigate the ultrasonographic, characteristics of the tissues and its relationship with the postoperative intraocular pressure(IOP) control. Twenty-three eyes of 23 patients had undergone the e-PTFE membrane-silicone tube implantation and had been followed up for at least 6-month(mean +/- SD, 17 +/- 8.8 months). An ultrasonographic study for these eyes included such paramneters as presence of an aqueous reservoir surrounding the implant, size(height) of the aqueous reservoir and echoreHectivity from the reservoir wall tissues. The aqueous reservoir was identified in 22(96%) of 23 eyes and had a height varying from 1.0 mm to 5.5 mm. In eyes with an aqueons reservoir. 3 mm high or more, the IOPs were all 21 mmHg or less without further glaucoma medications(p=0.040, chi-square). In one eye with an obliterated reservoir on ultrasonography, the opening of the silicone tube was found to be occluded toward the extrascleral portion of the implant when reoperation was performed. The echo reflections from reservoir wall tissues were denser and higher comparing with those from the sclera of the respective eye in 7 eyes with a complete failure of postoperative lOP control(>or=30 mmHg on maximum medical theraph). These eyes also had and irregular echoreflections within the aqueous reservoir, which reflect an invasion of proliferating tissues into the reservoir.

Eyeball Enlargement Induced by Monocular Iatrogenic Cataract in Chickens

In chicks, visual deprivation lead to myopia and enlargement of the vitreous chamber of the eye. In an attempt to elucidate the eyeball enlargement by iatrogenic cataract, two-day old white Leghorn chickens(n=28) were lightly anesthetized with ether and iatrogenic cataract was induced by YAG laser. The other eye was used as control group. Refractive error, corneal curvature, and axial length by ultrasonography were assessed before the study, and 3 weeks and 6 weeks after cataract formation. At 6 weeks, intraocular pressure, dimension changes and weight of enucleated eyeball were measured. The axial lengths in the iatrogenic cataract eye group were significantly larger than their control eyes in both the axial and the equatorial dimensions. Corneal sag and diameter, intraocular pressure, were not significantly different between two groups. We conclude that form vision deprivation with cataract induces the enlargement of the eyeball, especially the posterior segment of the eyeball.

5-Fluorouracil and Scleral Flap Splitting After Trabeculectomy

We introduced a method of splitting the lamellar scleral flap(LSF) after trabeculectomy with 5-fluorouracil(5-FU) to evaluate the postoperative wound strength which may reveal directly th6 antiproliferative effect of 5-FU. An 8-0 nylon sture was placed under the LSF at the time of trabeculectomy and both ends of the suture were drawn out from the conjunctiva. The wound strength was evaluated by pulling out the spitting suture at the end of second week after operation. Seventeen eyes of 16 patients underwent a primary trabeculectomy and placement of a splitting suture. 5-FU was injected subconjunctivally, 5 mg every other day in the eyes during postoperative two weeks. Five(50%) of ten eyes of 5-FU group resulted in LSF splitting(p=0.0407, Fisher's exact test). This result may signify that the LSF splitting suture technique will be a helpful means to investigate the effect of post-trabeculectomy wound healing modulators in the early period postoperatively.

5-Fluorouracil and Scleral Flap Splitting After Trabeculectomy

We introduced a method of splitting the lamellar scleral flap (LSF) after trabeculectomy with 5-fluorouracil (5-FU) to evaluate the postoperative wound strength which may reveal directly the anti proliferative effect of 5-FU. An 8-0 nylon sture was placed under the LSF at the time of trabeculectomy and both ends of the suture were drawn out from the conjunctiva. The wound strength was evaluated by pulling out the spitting suture at the end of second week after operation. Seventeen eyes of 16 patients underwent a primary trabeculectomy and placement of a splitting suture. 5-fU was injected subconjunctivally, 5mg every other day in the eyes during postoperative two weeks. Five (50%) of ten eyes of 5-FU group resulted in LSF splitting (p=0.0407, Fisher's exact test). This result may signify that the LSF splitting suture technique will be a helpful means to investigate the effect of post-trabeculectomy wound healing modulators in the early period postoperatively.

A Case of Angled tuck of the Medial Recti: A New surgical approach to Convergence Insufficiency

Patients with convergence insufficiency were complaint from diplopia and asthenopia at near Most patients respond well to orthoptic therapy, glasses, prism. In the case of patient unresponsive to conventional non-surgical orthoptic treatment, surgery remained controversial due to recurrence of symptoms reported following conventional bilateral medial rectus resection. To overcome these problems, an angled tuck of the medial recti was performed. Strengthening of the lower margin of the medial recti, by tucking them more than these of the upper margin results in a same aligment of the eye for near and distance deviation and relief of symptoms.

Treatment of Infectious Endophthalmitis

Endophthalmitis is a rare but catastrophic complication of intraocular surqeries and penetrating injuries. In spite of advances in diagnosis and therapy, the overall prognosis for recovery of useful vision has been regarded as poor. We experienced eight cases of endophthalmitis and performed vitrectomy combined with intravitreal antibiotics. Four(50%) had a final isual acuty of 0.2 or better. Vitrectomy was performed in cases of advanced intraocular inflammation, and intraocular lens was removed for suspected fungal endophthalmitis or to facilitate performance of a vitrectomy. A sample of vitreous, diluted by the irrigating solution, was passed through a disposable membrane filter system and inoculated into the culture media. Modification of therapy after initial broad spectrum antibiotics was based on the culture results and clinical responses. Repetitive intraocular antibiotic injections or reoperation were performed in severe cases.