The Minimal Postoperative Follow-Up Period to Determine Secondary Surgery in Patients with Intermittent Exotropia

PURPOSE: We investigated the recommended minimum postoperative follow-up period for the determination of secondary corrective surgery for the consecutive esotropia (ET) and recurrent exotropia (XT) after the first intermittent XT surgery. METHODS: The medical records of 728 patients who underwent surgical treatment for intermittent XT between 2004 and 2009 with a minimum postoperative follow-up of 1 year were retrospectively reviewed. Each patient underwent a detailed sensory and motor examination, including measurements of near and distance stereoacuity, alternating-cover test, and extraocular muscle function testing. Consecutive ET was defined as esodeviation over 15 prism diopter (PD) at distance persisting for more than 6 months after surgery despite medical treatment. Recurrent XT was defined as exodeviation over 15 PD at distance after surgery despite medical treatment. RESULTS: The mean age of the 728 patients at first surgery was 7.5 years (range, 22 months - 30 years). When only the motor outcome was considered, 663 patients (91.1%) had an orthrotropia at the final follow-up and 44 patients (6.0%) among consecutive ET patients and 21 patients (2.9%) who had a recurrent XT underwent secondary surgical correction. Binocularity decreased postoperatively in patients with consecutive ET (p < 0.001), whereas the other patients demonstrated improved stereopsis postoperatively (p = 0.041, 0.021). Patients with consecutive ET showed esodeviation over 10 PD when compared with orthotropia after 2 months postoperatively (p = 0.005). At 6 months postoperatively, 17 (81.0%) of 21 patients with recurrent XT showed orthotropia with an exodeviation over 11 PD after 18 months postoperatively. CONCLUSIONS: The success rate of surgical correction for intermittent XT showed a favorable outcome. However, careful concern for consecutive ET and recurrent XT are required in postoperative follow-up periods. Over-corrected or consecutive ETs need early surgical correction because no further improvement of ocular alignment will occur after 2 months postoperatively and delayed correction can result in poor sensory binocularity. Under-corrected or recurrent XT should be observed for an extended period because of the exotropic drift after surgery, thus requiring periodic long term follow-up for secondary surgery at least for 18 months postoperatively.

The Minimal Postoperative Follow-Up Period to Determine Secondary Surgery in Patients with Intermittent Exotropia

PURPOSE: We investigated the recommended minimum postoperative follow-up period for the determination of secondary corrective surgery for the consecutive esotropia (ET) and recurrent exotropia (XT) after the first intermittent XT surgery. METHODS: The medical records of 728 patients who underwent surgical treatment for intermittent XT between 2004 and 2009 with a minimum postoperative follow-up of 1 year were retrospectively reviewed. Each patient underwent a detailed sensory and motor examination, including measurements of near and distance stereoacuity, alternating-cover test, and extraocular muscle function testing. Consecutive ET was defined as esodeviation over 15 prism diopter (PD) at distance persisting for more than 6 months after surgery despite medical treatment. Recurrent XT was defined as exodeviation over 15 PD at distance after surgery despite medical treatment. RESULTS: The mean age of the 728 patients at first surgery was 7.5 years (range, 22 months - 30 years). When only the motor outcome was considered, 663 patients (91.1%) had an orthrotropia at the final follow-up and 44 patients (6.0%) among consecutive ET patients and 21 patients (2.9%) who had a recurrent XT underwent secondary surgical correction. Binocularity decreased postoperatively in patients with consecutive ET (p < 0.001), whereas the other patients demonstrated improved stereopsis postoperatively (p = 0.041, 0.021). Patients with consecutive ET showed esodeviation over 10 PD when compared with orthotropia after 2 months postoperatively (p = 0.005). At 6 months postoperatively, 17 (81.0%) of 21 patients with recurrent XT showed orthotropia with an exodeviation over 11 PD after 18 months postoperatively. CONCLUSIONS: The success rate of surgical correction for intermittent XT showed a favorable outcome. However, careful concern for consecutive ET and recurrent XT are required in postoperative follow-up periods. Over-corrected or consecutive ETs need early surgical correction because no further improvement of ocular alignment will occur after 2 months postoperatively and delayed correction can result in poor sensory binocularity. Under-corrected or recurrent XT should be observed for an extended period because of the exotropic drift after surgery, thus requiring periodic long term follow-up for secondary surgery at least for 18 months postoperatively.

Refractive Errors and Strabismus in Down's Syndrome in Korea

PURPOSE: The aims of this study were to examine the distribution of refractive errors and clinical characteristics of strabismus in Korean patients with Down's syndrome. METHODS: A total of 41 Korean patients with Down's syndrome were screened for strabismus and refractive errors in 2009. RESULTS: A total of 41 patients with an average age of 11.9 years (range, 2 to 36 years) were screened. Eighteen patients (43.9%) had strabismus. Ten (23.4%) of 18 patients exhibited esotropia and the others had intermittent exotropia. The most frequently detected type of esotropia was acquired non-accommodative esotropia, and that of exotropia was the basic type. Fifteen patients (36.6%) had hypermetropia and 20 (48.8%) had myopia. The patients with esotropia had refractive errors of +4.89 diopters (D, +/-3.73) and the patients with exotropia had refractive errors of -0.31 D (+/-1.78). Six of ten patients with esotropia had an accommodation weakness. Twenty one patients (63.4%) had astigmatism. Eleven (28.6%) of 21 patients had anisometropia and six (14.6%) of those had clinically significant anisometropia. CONCLUSIONS: In Korean patients with Down's syndrome, esotropia was more common than exotropia and hypermetropia more common than myopia. Especially, Down's syndrome patients with esotropia generally exhibit clinically significant hyperopic errors (>+3.00 D) and evidence of under-accommodation. Thus, hypermetropia and accommodation weakness could be possible factors in esotropia when it occurs in Down's syndrome patients. Based on the results of this study, eye examinations of Down's syndrome patients should routinely include a measure of accommodation at near distances, and bifocals should be considered for those with evidence of under-accommodation.

Effect of 23-gauge Sutureless Vitrectomy & Preoperative Bevacizumab on Results of Diabetic Vitrectomy

PURPOSE: To investigate the results of 23-gauge sutureless vitrectomy and preoperative bevacizumab in diabetic retinopathy cases. METHODS: A total of 212 eyes received pars plana vitrectomy by a single surgeon for proliferative diabetic retinopathy and were followed up for at least 6 months. The change of visual acuity and operative complications among the 20-gauge vitrectomy (group I, 86 eyes), 23-gauge vitrectomy (group II, 30 eyes), and 23-gauge vitrectomy with preoperative intravitreal bevacizumab (IVB) injection (group III, 96 eyes) were retrospectively analyzed. RESULTS: One month postoperatively, visual improvement was better in groups II and III than in group I. Three months postoperatively, visual improvement was better in group III than in groups I and II. Six months postoperatively, visual improvement in group III was better than in group I, but there was no significant difference between group II and III. Intraoperative retinal breaks and postoperative vitreous hemorrhage were less common in group III than in groups I and II. CONCLUSIONS: In patients with proliferative diabetic retinopathy, 23-gauge sutureless vitrectomy showed faster visual recovery compared with 20-gauge vitrectomy, and vitrectomy with preoperative bevacizumab had less intraoperative and postoperative complications than vitrectomy without preoperative bevacizumab.

Leber's Idiopathic Stellate Neuroretinitis with Peripapillary Serous Retinal Detachment

PURPOSE: To report a patient with Leber's idiopathic stellate neuroretinitis accompanying peripapillary sensory retinal detachment detected with optical coherence tomography. CASE SUMMARY: A 26-year-old woman complained of visual disturbance in her right eye for several months. Her best corrected visual acuity was 0.5 in the right eye and 0.9 in the left eye. A relative afferent papillary defect was present in the right eye. Severe disc swelling with retinal hemorrhage and stellate macular exudates were observed in the right eye. Fluorescein angiography revealed optic disc leakage. There appeared to be no leakage from the other retinal vessels or from the retinal pigment epithelium. OCT revealed outer nuclear-plexiform layer fluid accumulation in the papillomacular region. Eight weeks after steroid treatment, the best corrected visual acuity in the right eye had improved to 0.7, and the optic disc edema had improved. The OCT showed that the fluid in the outer nuclear-plexiform layer space had largely been absorbed.

A Case of Isolated Squamous Cell Carcinoma of the Orbit

PURPOSE: To report a case of isolated squamous cell carcinoma of the orbit. CASE SUMMARY: A 75-year-old man with over a 50 pack-year history of smoking presented discomfort and visual disturbance of the left eye for several months. His best-corrected visual acuity was 0.3, intraocular pressure was 9 mm Hg, and extraocular movements were normal. Slit-lamp examinations revealed no specific findings in the anterior segment in the left eye. However, retinal exams showed an oval-shaped, juxtapapillary mass-like lesion associated with retinal folding in the left eye. A huge, distorted echoic mass with an initial prominent spike and low-to-medium internal reflectivity with diminishing amplitude was observed on ocular ultrasonography. Enhanced CT revealed a highly-intense, irregular-circumscribed heterogeneous mass (2.0 x 2.0 x 1.5) in the superomedial quadrant of the left eye. Metastatic workups, including bone scan and CT of the head, neck, chest, and abdomen, were unremarkable. One week after the initial visit, the patient experienced pain and reduced visual acuity (light perception) in the left eye. Following the diagnosis, enucleation with tumor resection and hydroxyapatite implantation was performed. Histopathologic examination revealed a moderated-differentiated squamous cell carcinoma invading the sclera. The patient subsequently underwent radiation treatment and no evidence of recurrence was reported 6 months after surgery.