The Effect of Advancement of the Lateral Rectus Muscle on the Consecutive Esotropia

The operation methods for consecutive esotropia were various according to operators and the standard criteria for the amount of procedure was absent. We investigated the results of 7 patients who underwent advancement of the lateral rectus muscle for consecutive esotropia to estimate the corrected prism diopters per 1mm deviation of the lateral rectus muscle(delta/mm). The mean corrected amount of deviation was 2.01 delta/mm in 370 patients who underwent bilateral rectus muscles recession and 3.89 delta/mm in 7 patients who were brought about consecutive esotropia after recession of bilateral rectus muscles. There was a statistically significant difference between them(P0.05). This result suggests that we should adjust the amount of advancement of the lateral rectus muscle according to the effect of corrected amount by the recession of lateral rectus muscle of the previous surgery.

Complicated Cataract Following Radial Keratotomy

For correction of myopia, we had performed 247 cases of 8-incision radial keratotomy from July 1986 to Dec. 1987. Among them, we experienced one case of complicated cataract in 23 year old man. During the surgery, there were no surgical complications, including microperforation. Postoperative uncorrected V.A. was 0.9 at 1 day after surgery. At 2 days after surgery, V.A. decreased abruptly, and corneal edema, hypotony, severe iritis were noted. Although corneal edema and iritis were improved 10 days later, decreased V.A. and hypotony persisted. Posterior synechia, iris atrophy and posterior subcapsular cataract could be seen on follow-up examination. An intumescent cataract developed about 6 weeks after the surgery. Successful extracapsular cataract extraction was done about 11 months after the original radial keratotomy. Postoperative corrected V.A. was excellent.

Clinical Observation on a Case of Double Elevator Paralysis

Double elevator paralysis is a syndrome in which the superior rectus and the inferior oblique muscle of the same eye are paralyzed. The authors have experienced a case of double elevator paralysis with 35 prism diopters hypotropia and 20 prism diopters exotropia on the right eye. The patient was 19 years old female who visited our hospital because of poor cosmetic appearance. Knapp procedure was performed primarily to correct hypotropia, but 20 prism diopters hypotropia remained. 5 months later, a second operation was performed consisted of 7.5 mm recession of the left lateral rectus and 5mm recession of the right inferior rectus in order to correct the exotropia and residual hypotropia. After the second operation, ocular position in primary position was nearly orthophoric and upward movement of the right eye was considerably improved.

Posterior Capsular Rupture in Planned ECCE for Posterior Chamber Intraocular Lens Implantation

The incidence of inadvertent posterior capsular rupture at each stage of planned ECCE and posterior chamber intraocular lens implantation was studied. From June 1985 to Dec. 1986, 133 cases of planned ECCE for posterior chamber intraocular lens implantation were performed. Posterior capsular rupture with or without vitreous loss was developed in 11 cases(8.2%) out of 133. The rupture occurred during nuclear expression in 2 cases(1.5%), during cortical clean-up in 6 cases(4.5%), during remval removal of anterior capsular flaps in 2 cases(1.5%), during posterior chamber intraocular lens implantation in 1 case(0.7%), but during posterior capsule polishing in nocase(0%). Vitreous loss was combined with posterior capsular rupture in 6 cases(4.5%), but the other 5 cases were not associated with vitreous loss(3.7%). After management of vitreous loss by automated anterior vitrectomy in 10 cases, anterior chamber intraocular lens was implanted. But in the other 1 cases with mid posterior capsular rupture without vitreous loss, anterior chamber intraocular lens was implanted without anterior vitrectomy. A final visual acuity of 0.5 or better by 2 months postoperatively was observed in 10 cases out of 11(91%).