Tendon expansion with fascia lata in treatment of A-pattern strabismus due to superior oblique overaction

In 1991, Wright described a superior oblique expander procedure for browns syndrome and superior overaction with good results. Originally, this procedure has been performed with silicone band expander. The aim of this study was to report the results of treatment of a series of patients with A pattern strabismus associated with overacting superior oblique muscle using the fascia lata tendon expander technique. A total of 12 patients with bilateral overaction of the superior oblique muscle and A-pattern strabismus were treated with bilateral superior oblique lengthening with fascia lata according to the values recommended by Wright. Fascia lata was harvested through a lineal incision on the lateral aspect of the patients' thigh. The follow-up was 4 to 51 months [mean, 28.8 +/- 20.7 months]. Mean superior oblique overaction improved from 3.5 +/- 0.8 before surgery to 0.8 +/- 0.9 after surgery [P<0.001]. Mean A-pattern improved from 26.4 +/- 8.5 PD to 1.7 +/- 7 PD [P<0.001], and subjective intorsion improved from 6 +/- 0.7 degree to 0.3 +/- 1.1 degree [P<0.001]. One patient developed overcorrection. None of the patients developed recurrence. The fascia lata tendon spacer is a useful procedure in the treatment of A-pattern strabismus due to superior oblique overaction. This technique may be superior to posterior tenectomy because of less incidence of superior oblique overaction recurrence; however, the operation time is longer

Histopathologic changes of extraocular muscle fibers after injection of botulinum toxin

Use of botulinum toxin is becoming a popular way in treatment of some forms of strabismus. To evaluate the morphological changes in the orbital surface layer muscles of the rabbit eye following a single injection of botulinum toxin. 10 white Dutch rabbits weighing 2-3 kg received either 10 units [group 1; n=5] or 20 units [group 2; n=5] of botulinum toxin into the superior rectus muscle of right eye. The superior rectus muscle of the left eye in each rabbit was considered as control. The diameter of at least 20 muscle fibers of the orbital layer of the superior rectus muscle was measured with an ocular micrometer on histological sections after extirpation 2 and 1 0 days, and 4, 8 and 1 2 weeks after the injection. Marked decrease in size of muscle fibers was observed, especially on 2 and 10 days post-injection. It was more sever in animals which received 20 units of the toxin. In both groups, between 4 and 12 weeks after injection, the size of some fibers returned back to normal; rarely, the fibers became hypertrophic while atrophic changes were still present. Hypertrophy of neuro-muscular end-plate was seen accompanied with atrophic changes. Fibrosis around the muscle fibers was rarely seen. Injection of botulinum toxin into extraocular muscles causes atrophic changes which seems to be more severe with higher doses. The effect of botulinum toxin has been persisted up to 8 weeks

[Microbial inhibitional in non-inflamed human aqueous after oral antibiotic intake]

To investigate the penetration of cefixime, cephalexin and ciprofloxacin into the human eye based on microbial inhibition by human aqueous samples after oral administration. Sixty patients aged 40 to 75 years who were scheduled for cataract surgery were divided into three equal groups. One group received 500 mg oral ciprofloxacin 24, 12 and 2 hours preoperatively; another group received 500 mg oral cephalexin 24, 18, 12, 6 and 2 hours before the operation and the third group received 400 mg oral cefixime 24, 12 and 2 hours prior to surgery. Immediately before opening the anterior chamber, 0.1 ml of aqueous was taped with an insulin syringe. A 4 ml sample of the patient's blood was obtained simultaneously. Aqueous and serum specimens as well as a standard antibiotic disc were placed on the culture media of a known bacterium which was completely sensitive to the respective antibiotic. After 48 hours microbial inhibition zone of each sample was compared to the standard antibiotic disc. No microbial inhibition zone was seen by aqueous samples, however very large zones of inhibition were seen by discs of serum samples and antibiotics. It seems that oral cefixime, cephalexin and ciprofloxacin do not achieve effective concentrations in human aqueous for microbial inhibition

[Cataract etiology in children less than 3 years of age at Khalili hospital, Shiraz-Iran]

To evaluate the etiology of cataracts in children less than 3 years of age particularly the association of rubella virus infection and galactosuria with congenital cataracts at Khalili Hospital, Shiraz-Iran from 2003 to 2006. This prospective study included 46 patients less than 3 years undergoing lensectomy for the management of significant cataracts. Lens aspirate specimens were obtained from some cases. Serum samples for detection of anti-rubella IgM and IgG antibodies and urine samples for detection of galactose were also obtained. Out of 46 patients, 78.3% had congenital cataracts and 21.7% had traumatic cataracts. Patients with congenital cataracts were male in 45% and female in 55% with mean age of 5.12 +/- 5.23 months at the time of diagnosis. In the congenital cataract group, 2.8% had history of failure to thrive and 16.7% had low birth weight; 80.6% had bilateral and 19.4% had unilateral cataracts; 77.8% had isolated cataracts, 16.7% were associated with other ocular disorders and 5.6% were associated with systemic diseases; 11.1% had family history of congenital cataracts and 10.5% had galactosuria. Rubella virus was isolated from one [5.3%] of 19 cultured lens aspirates. No cases had anti-rubella IgM antibody. Congenital cataract is the most common type of cataracts in children under age 3 years in our area and most of them are idiopathic. The prevalence of rubella induced cataract in our country is less than developing countries but more than developed countries