Surgery in a Patient with Sensory Exotropia with an Abnormally Attached Lateral Rectus Muscle

Purpose@#We report surgical repair of an abnormally attached lateral rectus muscle in a sensory exotropia patient.Case summary: A 21-year-old man visited our hospital with lateral deviation in the right eye. The patient had a history of trauma (11 years previously) to the right eye, which showed 30 prism diopters of exotropia. In accordance with a diagnosis of sensory exotropia, 7.5-mm lateral rectus muscle recession and 6-mm medial rectus muscle resection were planned in the right eye. During surgery, the lateral rectus muscle was inserted into the sclera at a distance of 12 mm from the corneal limbus. To compensate for this, the lateral rectus muscle was recessed with an adjustable suture. After surgery, the patient showed 8-10 prism diopters of exotropia. A 2-mm recession was achieved by suturing. After surgery, the patient did not show exotropia, while after 3 months of follow-up the patient showed about 4 prism diopters of esotropia. @*Conclusions@#Despite abnormal attachment of an extraocular muscle, it is possible to obtain a good cosmetic result if the surgery is performed according to the preoperative plan. Suturing can be helpful if the surgical field is difficult to secure during the surgery.

Macular Ischemia Correlated with Final Visual Outcome in Retinal Vein Occlusion Patients

PURPOSE: To identify the correlation between final visual outcome after at least 6 months of follow-up and the extent of macular ischemia on the first visit. METHODS: We performed a retrospective clinical analysis of macular ischemia using clinical records, fundus examinations, and fluorescein angiographies in 83 patients (86 eyes) diagnosed with retinal vein occlusion from January 1998 to July 2012 and followed up for over 6 months. We evaluated the extent and the location of macular ischemia, macular edema, initial and final visual acuities and systemic disease based on fluorescein angiography and optical coherence tomography performed within 2 weeks of the first visit. The patients were divided into the following 4 groups based on the extent and location of macular ischemia and edema: superotemporal, superonasal, inferotemporal, and inferonasal. RESULTS: Retinal vein occlusions (RVOs) consisted of 24 central RVOs (CRVOs) and 62 branch RVOs (BRVOs). Mean initial acuity (log MAR) was 0.35 +/- 0.31 (36 eyes) in the no macular ischemia group, 0.40 +/- 0.21 (11 eyes) in the 1-quadrant macular ischemia group, 0.71 +/- 0.32 (26 eyes) in the 2-quadrant macular ischemia group and 0.73 +/- 0.36 (13 eyes) in the over 3 quadrants macular ischemia group. Mean final acuity (log MAR) was 0.23 +/- 0.23 in the no macular ischemia group, 0.40 +/- 0.30 in the 1-quadrant macular ischemia group, 0.51 +/- 0.32 in the 2-quadrant macular ischemic group and 0.73 +/- 0.31 in the over 3 quadrants macular ischemia group. CONCLUSIONS: The initial and final visual outcomes were worse when more quadrants were affected by macular ischemia. The extent of macular ischemia was correlated with initial visual acuity and final visual outcome but not with macular edema.

Stability and Sterility of Bevacizumab after Withdrawal into a Syringe and Refrigeration or Freezing

PURPOSE: The aim of this study was to evaluate the stability and sterility of bevacizumab (Avastin, Genentech, Inc., San Francisco, CA, USA) after withdrawal into multiple doses from single-use vials. METHODS: Bevacizumab was repeatedly and aseptically drawn from new vials into 1 cc plastic syringes and refrigerated in the dark at 4degrees C for 0, 3, 6, 12, 28, 38, 46, 52, or 63 weeks or at -10degrees C for 0, 3, 6, 12, 38, 46, or 52 weeks. The stability of bevacizumab was assessed by enzyme-linked immunosorbent assay (ELISA) and compared with that of controls (0 weeks). The contents of the fractionated bevacizumab syringes were analyzed for microbial growth. RESULTS: When we assessed the relative stability of the bevacizumab stored at 4degrees C, there was no concentration change for up to 12 weeks. However, concentration decreased by less than 2% between 28 weeks and 46 weeks. Samples stored at -10degrees C were stable up to 52 weeks. All of the fractionated syringes maintained >90% stability compared with controls for up to one year in both the refrigerated group and the frozen group. The microbial study showed no significant positive results for up to 12 weeks. After intravitreal bevacizumab injection, the statuses of all patients improved, with no signs of intraocular infection. We observed no cases of intraocular infection or complications among the patients. CONCLUSIONS: Fractionating and storing smaller amounts from single-use vials is a safe method for intravitreal bevacizumab injection.