Intravitreal Bevacizumab for Macular Edema Secondary to Ruptured Retinal Arterial Macroaneurysm

PURPOSE: To study the short-term effect of intravitreal injection of bevacizumab in the treatment of macular edema secondary to retinal macroaneurysm. METHODS: Eight eyes of 9 patients who underwent consecutive intravitreal bevacizumab injections for macular edema secondary to retinal macroaneurysm were prospectively evaluated. Complete eye examination including the best corrected visual acuity (BCVA), fundus examination and optical coherence tomography (OCT) were performed at baseline and follow-up visits at 2, 4 and 6 months. RESULTS: The mean age was 73.6 +/- 6.9 years, and the mean study period was 7.3 +/- 2.6 months. At the final visit, BCVA improved from log MAR 1.92 +/- 0.67 to log MAR 0.87 +/- 0.57. The mean central macular thickness on OCT image decreased from 388 +/- 168 microm at the initial visit to 200 +/- 39 microm at the final visit. Three eyes without subretinal hemorrhage presented better visual outcome than eyes with subretinal hemorrhage. All eyes showed some decrease in angiographic leakage. No adverse side effects were observed following the injections. CONCLUSIONS: Intravitreal bevacizumab injection can be used as a selective alternative treatment modality for macular edema secondary to retinal macroaneurysm.

Prevalence and Risk Factors of Peripheral Artery Disease in Elderly Chronic Ischemic Stroke Patients: A Study of a Single Geriatric Hospital

BACKGROUND: Peripheral artery disease (PAD), which is caused by atherosclerosis of the peripheral vessels, is a progressive disease, especially in patients with many of the vascular risk factors. The aim of this study was to investigate the prevalence and risk factors of PAD in elderly chronic stage ischemic stroke patients in Korea. METHODS: Ninety-six elderly patients (> or =60 years) admitted to a local geriatric hospital with ischemic stroke in the chronic stage (mean duration of stroke, 590 days) were included in this study. Vascular risk profiles, routine blood tests, severity of stroke and ankle-brachial index (ABI) were measured. RESULTS: Of the 96 patients, 55 (57.3%) had PAD (ABI<0.9) of which 6 patients (6.3%) had severe PAD (ABI<0.5) and 22 patients (22.9%) had bilateral PAD. PAD was more frequently observed in patients with diabetes (65% vs. 15%, p=0.001), hypercholesterolemia (65% vs. 15%, p<0.001), previous history of coronary artery disease (CAD) (25% vs. 5%, p=0.01) and recurrent ischemic stroke (36% vs. 12%, p=0.01). The means of the total cholesterol and blood urea nitrogen were higher in patients with PAD. From the results of the binary logistic regression analysis, presence of diabetes (odds ratio [OR], 4.740; p=0.026), hypercholesterolemia (OR, 18.991; p<0.001), previous history of CAD (OR, 7.579; p=0.038) and lower Korean version of Modified Barthel Index (OR, 0.971; p=0.009) were independent risk factors for PAD. CONCLUSION: PAD is frequently observed in elderly patients with chronic ischemic stroke. Measuring ABI to diagnose PAD and controlling risk factors may be beneficial in these patients seen at geriatric hospitals and centers.

Contouring of Forehead and Temple Area with Auto-Fat Injection

PURPOSE: Facial contouring surgery for improving congenital, acquired deformity and senile change were attempt in past. Recently contouring surgery became more interested subject for improving the flat forehead and temple area. Many synthetic materials were used such as Collagen, silicon, polyacrylamide gel as liquid form and Gore-tex, silicon implant, endotine as solid form. But, these synthetic implants associate complications as foreign body reaction, infection, displacement, granuloma formation and absorption. Auto-fat injection are used for disfigurement of many part of body. We did auto-fat injection for facial contouring of forehead and temple region. Auto-fat injection is suitable without foreign body reaction, displacement, and toxic reaction. Also auto-fat is relatively simple to obtain from patient and less expensive and able to repeat surgeries. METHODS: From 2006 to 2009, 150 patients were treated with Auto-fat injection for facial contouring. For follow up, we sent questionnaire to all patients but 110 patients returned answer sheets. The patients consisted of 20 male patients and 90 female patients with an age ranged from 26 to 60, and the mean 43. Fat tissue were injected 6-8cc in forehead, 7-12cc in temple area and fat were harvested from thigh and abdomen. RESULTS: In follow up, all patients, showed absorption of injected fat varied degree and except two patients all patients underwent secondary fat injection. Complications were minimal and neuropraxia of facial nerve were recovered. Most of the patients were satisfied with result of procedure, and answered that they recommend same procedure to their friends and will do surgery again. CONCLUSION: Auto-fat injections were implemented for facial contouring in 150 patients and obtained satisfactory result. Auto-fat injection is relatively easy procedure and applicable widely. Even though, by passing time, some of the injected fats are absorbed, auto-fat injection could be choice of treatment for contouring forehead and temple. With accumulations of cases and development of surgical technique, better result could be expected.

Clinical and Statistical Analysis in 452 Cases of Nasal Bone Fracture Patients

PURPOSE: Nasal bone fracture is most common facial bone fracture. The cause of fractures is mainly trauma such as fighting, automobile accident and fall down, and it commonly involves young males. Very frequently nasal bone fractures are associated with other facial injuries such as orbital bone fracture, maxillary bone fracture and nasal septal deformities. Because of various dynamic directions of power are involved, phenomenon of fractures are also various and treatment cannot be simple. METHODS: We studied and analyzed retrospectively 452 cases nasal bone fractures from January 2008 to December 2010. Diagnosis were made with physical examination, Nasal bone X-rays, Facial bone CT and 3D facial bone CT. Four surgeons are involved in treatments of these patients and applied different procedure along patient's condition and deformity. We analyzed the cause of nasal bone fractures, deformities, associate injuries and applied surgical technique, and patient's satisfaction rate. In this study, old nasal bone fractures were excluded. RESULTS: Young male group was most commonly sustained nasal bone fracture and physical violence was most common cause of injury. 64 of 452 patient was involved associate injuries of face. Closed reduction were applied 246 cases and C-arm quide reduction were 167 cases and in 20 cases lateral osteotomy were applied. Approximately, more than 80% of the Patients were satisfied with the outcomes. CONCLUSION: Diagnosis and treatment of nasal bone fractures are considered simple but because of various deformity and associate injuries, treatment is not always simple and universal. Time to time, we face unsatisfied patient after treatment of nasal bone fractures. For obtaining satisfactory result, cause of injury and state of deformities and associate injuries such as nasal septal deformity should be evaluated properly and proper treatment should be applied.

Long-Term Visual Outcomes and Prognostic Factors for Successful Idiopathic Macular Hole

PURPOSE: To investigate long-term visual outcomes and prognostic factors to predict visual outcomes in patients with anatomic success after macular hole surgery. METHODS: Medical records of 36 eyes with successfully repaired stage 3 or 4 idiopathic macular hole and with at least 24 months of follow-up were reviewed. Hole height, stage of macular hole, base diameter, minimum diameter, hole form factor, macular hole index, and hole closure type were measured or calculated, and the correlations of visual outcomes with variables of preoperative optical coherence tomography (OCT) were analyzed. RESULTS: The patients were classified into 3 groups according to the time period necessary to achieve the best corrective visual acuity. The visual acuity of 16 eyes (44.4%) recovered in a mean of 6 months, 13 eyes (36.1%) improved slowly and continuously, and 7 eyes had no improvement despite successful anatomical closure. There were no statistical differences in hole height, base diameter, minimum diameter, hole form factor, macular hole index, or closure type among the 3 groups. CONCLUSIONS: The improvement in visual acuity after successful macular hole surgery persisted at the 24-month follow-up and after. There were no correlations between delayed visual acuity after macular hole surgery and minimum diameter, base diameter, hole height, hole form factor, macular hole index, or closure type.

The Results of Nation-Wide Registry of Age-related Macular Degeneration in Korea

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.

Subretinal Hemorrhage After Photodynamic Therapy for Age-Related Macular Degeneration

PURPOSE: To evaluate the clinical features of subretinal hemorrhage after photodynamic therapy in eyes with exudative age-related macular degeneration. METHODS: We retrospectively reviewed data for 267 eyes of 243 patients who had undergone PDT for the treatment of ARMD between January 2005 and December 2006. Best corrected visual acuity, fundus photography, fluorescein angiography, and ICG angiography were performed before and after treatment. We followed up the patients at 1 week, 1 month, and 3 months after treatment and at 3-month intervals thereafter. RESULTS: Postoperative subretinal hemorrhage was seen in 36 (13.4%) of 267 eyes. The pretreatment and post-treatment mean visual acuities were logMAR 0.80 and logMAR 1.05 respectively, representing a decrease of 2.05 lines. On FAG, two eyes were predominantly classic, four eyes were minimally classic, and 30 eyes were occult. The laser irradiation spot size was under 3,000 micrometer in one case and from 3,000 micrometer to 5,000 micrometer in 19 cases and over 5,000 micrometer in 16 eyes. CONCLUSIONS: Subretinal hemorrhage after PDT for ARMD can be a common complication in patients who have been treated for larger irradiation spot sizes and for pigment epithelial detachment (PED), so doctors should be aware of the risk of serious hemorrhagic complications in such situations.

Multifocal Electroretinogram before and after Epiretinal Membrane Surgery

PURPOSE: To assess macular function before and after vitrectomy and membrane removal in epiretinal membranes by means of multifocal electroretinogram (mfERG). METHODS: The mfERGs (RETIscan(R), Roland, Germany) of 28 consecutive patients (28 eyes) with idiopathic epiretinal membranes were recorded before epiretinal membrane surgery and 3 to 6 months after surgery. The average retinal response density and implicit time of each local response were estimated as anatomic macular areas corresponding roughly to 5 rings. Preoperative and postoperative responses of mfERG were compared. The correlation of the change of retinal response density and postoperative macular configuration on optical coherent tomography (OCT) was statistically analyzed. RESULTS: The postoperative value of P1 amplitude and implicit time were not statistically correlated with the preoperative value (p>0.05). There were no significant correlations between the changes of rings 1 and 2 with regard to the retinal response density of the mfERGs and visual acuity. There was no significant correlation between the change of retinal response density and postoperative macular configuration according to OCT. CONCLUSIONS: The use of mfERGs does not seem useful for predicting clinical prognosis after epiretinal membrane surgery. Further studies of influence of internal limiting membrane removal on mfERG response should be conducted.

Clinical Usefulness of Diffusion Tensor Image Tractography in Stroke Patients: Report of two cases

We report the clinical usefulness of elucidating the state of the corticospinal tract (CST) by the use of diffusion tensor image tractography (DTT) in hemiparetic stroke patients. DTT was performed using 1.5 T magnetic resonance imaging. DTT demonstrated that the CST of the affected hemisphere was preserved in the medial portion of the hematoma in patient 1, but was interrupted by a hematoma in patient 2. DTT seems to be useful for elucidating the status of the CST in hemiparetic stroke patients.

Macular Hole as a Risk Factor of Choroidal Detachment in Rhegmatogenous Retinal Detachment

PURPOSE: Choroidal detachment (CD) associated with rhegmatogenous retinal detachment (RRD) is a rare, but serious condition, which makes the prognosis worse. Previously reported risk factors for CD in RRD patients include high myopia, aphakia, pseudophakia, and advanced age. However, macular hole has not been discussed as an important factor in increasing the risk of CD in RRD patients. The purpose of this study was to evaluate macular hole as a risk factor for CD in eyes evidencing RRD. METHODS: The medical records of 480 patients with primary RRD were reviewed. We compared the CD incidence among the RRD patients in accordance with the presence or absence of macular holes. The relationship between gender, age, presence of systemic disease, refractive errors, lens status, intraocular pressure and the development of CD were also analyzed. RESULTS: The incidence (4/21 eyes, 19.0%) of CD in the RRD with macular hole was significantly higher than that (7/459 eyes, 1.5%) observed in the RRD without macular hole (p=0.010). The preoperative intraocular pressure (mean+/-SD; 2.5+/-1.3 mmHg) in the RRD with CD and macular hole was significantly lower than that (7.4+/-4.4 mmHg) observed in the cases of RRD with CD without macular hole (p=0.035). The eyes complicated by CD evidenced a higher prevalence of diabetes mellitus (p=0.024) than was observed in the eyes without CD. CONCLUSIONS: The retinal detachment combined with macular hole creates a predisposition toward the development of profound hypotony and CD.

Chronic Central Serous Chorioretinopathy: Photodynamic Therapy

PURPOSE: To evaluate the clinical results of photodynamic therapy (PDT) using verteporfin in patients with chronic central serous chorioretinopathy (CSC). METHODS: A retrospective study in a clinical practice setting of eight eyes (eight patients) with chronic CSC. The point of dye leakage on the fluorescein angiogram (FA) was too close to the fovea to treat these patients with focal laser treatment. Additionally, choroidal vascular hyperpermeability was observed with indocyanine green angiogram (ICGA). Patients were treated with verteporfin PDT and evaluated for visual acuity, complications, change in centralmacular thickness with the optical coherence tomogram (OCT), and recurrence. RESULTS: Pre-PDT visual acuity improved from 0.46 (0.04~0.7) to 0.82 (0.15~1.2) with an average of 15.2 months follow-up post-treatment (p=0.011). The mean central macular thickness also reduced from 283 micrometer to 135.5 micrometer. Central macular exudation resolved completely in all eyes. There was no recurrence after PDT. CONCLUSIONS: PDT with verteporfin appeared to be a beneficial treatment option for patients with chronic CSC.

Retinal Angiomatous Proliferation and Intravitreal Bevacizumab Injection

PURPOSE: To evaluate the short-term efficacy and safety of intravitreal bevacizumab injection (IVBI) in patients with retinal angiomatous proliferation (RAP). METHODS: Seven eyes of 5 patients with RAP were included in this study. All of the eyes evidenced stage 2 RAP lesions, except for one eye with a stage 3 lesion. IVBI (1.25 mg/0.05 cc) were conducted at 4 or 6-week intervals. Complete ocular examinations, angiographic results and optical coherence tomographic findings before and after the IVBI were analyzed at baseline and upon the follow-up visits. RESULTS: Seven eyes were studied in 5 patients who had undergone IVBI. Partial (3 eyes) or complete (4 eyes) regression of RAP was noted after IVBI in all of the studied eyes. Visual acuity improved in 5 of the eyes, and was stable in 2 of the eyes. One eye evidenced severe intraocular inflammation after IVBI and a subsequent development of new RAP, which was controlled with vitrectomy and repeat IVBI. CONCLUSIONS: This treatment was effective over 6 months, stabilizing or improving visual acuity and reducing angiographic leakage. These short-term results suggest that IVBI may constitute a promising therapeutic option, particularly in the early stages of RAP.

Effect of Aggressive Rehabilitative Treatment on Canalicular Sequestered Lumbar Disc Herniations : Long-term Follow-up Study

OBJECTIVE: To assess long term outcomes of aggressive rehabilitative treatment on canalicular sequestered lumbar disc herniations METHOD: Clinical outcomes of twenty four patients with sequestered disc herniation with symptomatic radicular pain were evaluated prospectively and longitudinally for one year. All patients received aggressive rehabilitative treatment including transforaminal epidural steroid injection, pelvic stabilization exercise, physical therapy, and back school. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry Disability Index (ODI) for back pain before treatment, posttreatment one, three, six, and twelve months. After twelve months, we categorized patients' satisfaction. Four patients were dropp RESULTS: The averages of VAS for lower extremity and back pain reduced significantly from 6.6 and 5.8 at pretreatment to 0.7 and 0.9 at 12 months posttreatment, respectively (p<0.001). The averages of ODI reduced significantly from 73.5% at pretreatment to 22.3% at posttreatment 12 months (p<0.001). Sixteen of twenty patients (80.0%) were satisfied with their current status posttreatment 12 months. CONCLUSION: Sequestered disc herniations could be treated successfully by aggressive rehabilitative treatment. Clinical improvement was achieved from posttreatment one month and persisted for twelve months. Operation might be delayed until aggressive rehabilitation treatment fail to treat sequestered disc herniations.

Purtscher-like Retinopathy after Scleral Fixation of IOL

PURPOSE: We report a case of Purtscher-like retinopathy following the removal of a dislocated IOL and scleral fixation of a new IOL. METHODS: A 60-year-old man presented with sudden visual loss of the right eye. An ophthalmologic examination revealed IOL dislocation. He underwent removal of the dislocated IOL and scleral fixation of the new IOL. Visual acuity was 0.02 in the right eye on the second postoperative day. A fundus examination and fluorescein angiography were performed. RESULTS: A peripapillary multiple cotton wool spot, pale macula and cherry red spot were noted in the right eye. Fluorescein angiography showed arteriolar obstruction around the macula and leakage of the mild arteriolar fluorescein dye. At one month follow-up, macular edema, hemorrhage and peripapillary cotton wool spots were increased. CONCLUSIONS: This case of Purtscher-like retinopathy following scleral fixation of the IOL did not have any obvious etiologic cause.

A New Method for Measuring Corneal Refractive Power after Refractive Surgery

PURPOSE: To report a new method for measuring corneal refractive power after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) using the Orbscan(R) and autorefractokeratometer. METHODS: This study involved 12 cases that had undergone cataract surgery after corneal refractive surgery. Five cases had PRK and seven had LASIK. Keratometric values were evaluated with three different methods. The first, defined as RK, used an autorefractokeratometer (AK) (n=1.3375). The second, defined as K1, added the posterior surface diopter using AK and anterior surface diopter using an Orbscan. The last, defined as K2, added the posterior surface diopter and the anterior surface diopter using an Orbscan. Low K was a lower value between K1 and K2. RK, K1, K2 and Low K were compared with the back-calculated K value (Real K) 2 months after cataract surgery. RESULTS: The mean differences between RK, K1, K2, Low K and Real K were 3.08 +/- 0.98D, 0.41 +/- 0.66D, 0.27 +/- 0.77D, and -0.02 +/- 0.53D, respectively. In 9 of the 12 patients the difference was within 1D (75%) when either K1 or K2 was selected and in all patients, the difference between Low K and Real K was within 1D. CONCLUSIONS: The method of IOL calculation using Low K showed more accurate and predictable results in patients who had had cataract surgery after corneal refractive surgery.

Foveal Retinal Detachment Diagnosed by Optical Coherence Tomography after Successful Retinal Detachment Surgery

PURPOSE: To investigate the time course and occurrence of foveal retinal detachment presenting with symptoms of metamorphopsia and decreased visual acuity after successful surgery for macula-off retinal detachment. METHODS: This study included 9 eyes of 9 patients who were diagnosed with foveal retinal detachment using optical coherence tomography (OCT) among 198 patients who had decreased visual acuity and metamorphopsia after successful rhegmatogenous retinal detachment surgery. RESULTS: All eyes were diagnosed with foveal retinal detachment by OCT. Foveal retinal detachment occurred after scleral buckling surgery in 8 eyes (88%) and after vitrectomy and pneumoretinopexy in 1 eye. The degree and frequency of foveal retinal detachment was milder and lower after vitrectomy and pneumoretinopexy than after scleral buckling surgery. All foveal retinal detachments were reattached spontaneously after 9 months (range, 5~14 months). In all eyes, the symptom of metamorphopsia was improved and visual acuity increased after the foveal retinal detachment was reattached. CONCLUSIONS: OCT can be used to diagnose foveal retinal detachment in cases when the fundus and fluorescein angiography do not show specific findings but, presenting symptoms of decreased visual acuity and metamorphopsia. In all cases evaluated, the foveal retinal detachment was reattached spontaneously without treatment.

Difference Between Postoperative Refraction and Predictive Refraction after Cataract Operation in Patients with Coexisting Cataract and Primary Angle-closure Glaucoma

PURPOSE: To report the difference between the postoperative spherical equivalent (SE) and predictive refraction in patients with cataract and primary angle-closure glaucoma (PACG) following cataract operation. METHODS: (1) This study involved 60 eyes who underwent cataract surgery due to PACG and cataract, and 36 eyes who underwent surgery due to cataract only. We measured the manifest refraction postoperatively for comparision to the target power. (2) The axial length (AL) was measured by the different modes of A-scans(phakic, aphackic modes) in the 38 eyes with cataract. (3) The difference was calculated according to the three IOL power calculation formulas for the 60 eyes who had cataract surgery for coexisting PACG and cataract. RESULTS: The difference between postoperative SE and predictive refraction was -0.61+/-0.91D in the PACG with cataract and +0.08+/-0.43D in eyes with cataract only. There was no difference according to the IOL power calculation formulas or the different modes observed in the measurement of AL. A greater difference was seen in eyes with a short AL and an unmeasurable ACD. CONCLUSIONS: The difference between postoperative SE and predictive refraction increased in eyes with the PACG and cataract over those with cataract only. For cataract operation in these eyes, the choice of a lower power IOL (about 0.5D) may be helpful to reduce this difference, especially for eyes with a short AL (less than 24 mm) and an unmeasurable ACD.

Macular Thickness Changes with Age in Normal Subjects Measured by Optical Coherence Tomography

PURPOSE: To evaluate the retinal thickness changes of the macula with age in normal subjects using optical coherence tomography. METHODS: Included were 56 patients with no systemic disease and no ophthalmoscopic evidence of retinopathy and who had a best corrected visual acuity of 1.0 or better. The measurement of the retinal thickness obtained by OCT III was analyzed using the computerized topographic mapping protocol (6 mm diameter map) according to age, refraction error, sex and macular region. We analyzed how they correlated to each other. RESULTS: The mean standard deviations of foveal thickness and retinal thickness within 1 mm diameter of the center were 182 +/- 26 micro meter and 208 +/- 18 micro meter in normal eyes, respectively. There was no statistically significant change with age (p>0.01). But the measurements at 3 and 6 mm from the fovea showed reduced retinal thickness with age (p0.01). There was a significant difference between the nasal quadrant and temporal quadrant within the 3 mm diameter of the center, and there was also a significant difference between the superior quadrant and inferior quadrant, and between the nasal quadrant and temporal quadrant within the 6 mm diameter of the center (p<0.01). CONCLUSIONS: Retinal thickness around the fovea as measured by OCT showed a decrease with age, although the fovea and the region within 1mm diameter of the center showed no statistical associations with age.

Surgical Effect of Augmented Modified Kestenbaum Procedure Combined with Conjunctival Recession for the Abnormal Head Position in Congenital Nystagmus

We performed surgery for correction of abnormal head turn in 10 patients with congenital nystagmus. For 3 patients with a head turn of 30 degrees, a 40% augmented modified kestenbaum operation was performed. For 4 patients with a head turn of 45 degrees, a 40% augmented modified kestenbaum operation combined with a 3 - 4 mm recession of conjunctival and subconjunctival tissues was performed. Finally, for 3 patients with a head turn of 60 degrees, a 60% augmented modified kestenbaum procedure combined with a 3 - 4 mm recession of conjunctival and subconjunctival tissues was performed. At the final follow-up visit(averaging 5.9 months), 7 patients showed complete corrections of previous head turn and 3 patients showed a small residual head turn of less than 10 degrees to the same side of the preoperative head turn. The average amount of correction we obtained from the surgery described above were 26.7, 42.5 and 56.7 degrees for the patients who had had a preoperative head turn of 30, 45 and 60 degrees respectively. Among the 10 patients, 4 showed no change in corrected visual acuity, but 6 showed increased corrected visual acuity by over 1 Snellen line. From the above results, we concluded that if recession procedure of the conjunctival and subconjunctival tissues was combined with augmented modified Kestenbaum procedure, its effect for correction of abnormal head turn in a patient with congenital nystagmus could be enhanced.