Contralateral Inferior Oblique Overaction after Inferior Oblique Recession in Unilateral Moderate Primary Inferior Oblique Overaction

PURPOSE: To investigate the incidence rate of inferior oblique muscle overaction (IOOA) in the contralateral eye and the effect of inferior oblique (IO) muscle recession of the contralateral eye in the patients who received IO muscle recession for unilateral moderate (+2 or +3) primary IOOA. METHODS: Medical records of 88 patients with unilateral primary IOOA who underwent unilateral IO muscle recession were retrospectively reviewed and observed during a follow-up period of more than 1 year. Graded recession of the IO muscle was performed according to the degree of IOOA. If postoperative IOOA was below +1, the surgery was considered successful. If IOOA in the contralateral eye was more than +2 after surgery, the IOOA was considered to have occurred. RESULTS: In cases where IOOA was +2 and +3 before the surgery, the success rate was 98.2% and 100%, respectively, showing an overall success rate of 98.8%. The incidence of contralateral IOOA after recession of the unilateral IO muscle was 24.1% in the +2 group and 16.6% in the +3 group with an overall incidence rate of 21.6% and when the IO muscle recession of the contralateral eye was performed, the success rate was 100%. CONCLUSIONS: The incidence of contralateral IOOA was 21.6% after the unilateral IO muscle recession in moderate unilateral primary IOOA. A satisfactory outcome was obtained through an additional IO muscle recession in the contralateral eye.

Pterygium Surgery: Wide Excision with Conjunctivo-Limbal Autograft

PURPOSE: To evaluate the efficacy of conjunctivo-limbal autograft after wide excision of primary and recurrent pterygia. METHODS: Twenty-one eyes of 18 patients with primary pterygium and 18 eyes of 18 patients with recurrent pteygium underwent conjunctivo-limbal autograft after wide excision of pterygium. All patients underwent follow-up for more than six months. Recurrence rates and complications were evaluated. RESULTS: With a minimum of six months of follow-up, fibrovascular tissue in the excised area, not invading the cornea, was noted in one eye (5.6%) in the recurrent pterygium group but no further surgical interventions for the cosmetic problem were needed. One eye (4.8%) showed wound dehiscence, three eyes (14.3%) showed subgraft hemorrhage, and one eye (4.8%) showed subconjunctival fibrosis at the donor site in the primary pterygium group, while two eyes (11.1%) showed subgraft hemorrhage, and one eye (5.6%) showed Tenon's Capsule granuloma at the donor site in the recurrent pterygium group. CONCLUSIONS: Conjunctivo-limbal autograft after wide excision of pterygium can be considered an effective treatment with low recurrence rates for both primary and recurrent pterygia.

Pterygium Surgery: Wide Excision with Amniotic Membrane Transplantation using Fibrin Glue

PURPOSE: To compare the efficacy and safety of fibrin glue and sutures for amniotic membrane transplantation after wide excision of primary pterygium. METHODS: Forty-three eyes of 37 patients underwent amniotic membrane transplantation for primary pterygium with a minimum follow-up period of six months. Twenty-three eyes of 18 patients underwent surgery with fibrin glue and 20 eyes of 19 patients underwent surgery with sutures. Recurrence rates, complications, operating time were evaluated. RESULTS: With a minimum of six-month of follow-up, fibrovascular tissue in the excised area, not invading the cornea (conjunctival recurrence), was noted in four eyes (17.4%) and fibrovascular tissue invading the cornea (corneal recurrence) was noted in two eyes (8.7%) in the fibrin glue group. Conjunctival recurrence was noted in five eyes (25%) and corneal recurrence was noted in one eye (5%) in the suture group. There was no significant difference in the recurrence rates between the two groups. Mean operating time in the fibrin glue group (25.2+/-3.5 minutes) was significantly shorter than in the suture group (40.5+/-3.6 minutes) (p=0.001, Students t-test). Complications included sub-amniotic membrane hemorrhage in three eyes (13%), and granuloma in one eye (4.3%) in the fibrin glue group, sub-amniotic membrane hemorrhage in four eyes (20%), granuloma in three eyes (15%), and wound dehiscence in one eye (5%) in the suture group. CONCLUSIONS: Using fibrin glue instead of sutures in amniotic membrane transplantation after wide excision of pterygium can be considered an effective treatment with shorter operating time and fewer complications, although there is no significant difference in recurrence rates.