Long-Term Results of Intermittent Exotropia Surgery: Comparison between Motor and Functional Success

PURPOSE: To evaluate the long-term surgical success rate (>3 years) and contributing success factors considering motor and sensory criteria for patients with intermittent exotropia. METHODS: Fifty-four patients who received surgery for intermittent exotropia and were followed-up for a minimum of 3 years, including reoperation, were retrospectively evaluated. The first procedure was unilateral recession and resection in 50 patients and bilateral lateral rectus recession in 4 patients. Patients were classified as achieving a good, fair or poor outcome based on motor and sensory criteria. Success rate and associated factors such as postoperative alignment, exotropia type, first surgical procedure, and proportion of patients receiving reoperations were analyzed. RESULTS: The mean follow-up period after the first surgery was 4.81 +/- 1.30 years. The good outcome was achieved in 32 patients (59.3%), fair in 14 patients (25.9%), and poor in 8 patients (14.8%) considering motor criteria only. The good outcome was achieved in 29 patients (51.9%), fair in 12 patients (22.2%), and poor in 14 patients (25.9%) when considering combined motor/sensory (functional) criteria. No patient who received bilateral lateral rectus recession as the first procedure belonged to the good outcome group (p = 0.03 by motor criteria and p = 0.044 by functional criteria). Patients who received reoperation were significantly more likely to be in the good and fair groups (p = 0.009 by motor criteria and p = 0.02 by functional criteria). CONCLUSIONS: Long-term surgical results of intermittent exotropia in this Korean population revealed 85.2% motor success rate and 74.1% functional success rate. Early postoperative overcorrection was not associated with long-term success. Recession and resection procedure and reoperations were significantly associated with better outcome based on motor and functional criteria. Diligent reoperations after the first surgery could possibly contribute to good long-term functional outcome in intermittent exotropia patients.

Consecutive Esodeviation After Exotropia Surgery in Patients Older than 15 Years: Comparison with Younger Patients

PURPOSE: The purpose of this study was to investigate the clinical course of esodeviation after exotropia surgery in older patients (older than 15 years) and to compare it with that in younger patients (15 years or younger). METHODS: The medical records of all surgeries for exodeviation from December 2004 to February 2007 were reviewed and 82 patients were found with consecutive esodeviation. The patients were divided into two groups according to their age: Group A (patients older than 15 years) and Group B (patients age 15 or younger). The clinical course of esodeviation in Group A was compared to that in Group B by means of survival analysis. RESULTS: The median survival times of the esodeviation were 2.0+/-0.1 months in Group A and 1.0+/-0.1 months in Group B (p=0.40). The prevalence of consecutive esotropia at six months was 0% in Group A and 6.1% in Group B (p=0.32). The myopic refractive error, worse sensory condition, and a larger preoperative exodeviation in Group A did not affect the clinical course of the two groups differently. CONCLUSIONS: The postoperative esodeviation of patients older than 15 years after exotropia surgery tended to persist longer during the early postoperative period than that of patients 15 years or younger, however, the difference did not persist at postoperative six months.

The Clinical Features of Korean Patients with Duane's Retraction Syndrome

PURPOSE: To describe the clinical features of Duane's retraction syndrome (DRS) in Korean patients. METHODS: We retrospectively analyzed the 78 DRS cases that presented to our department between 1995 and 2004. The clinical features investigated included sex distribution, laterality, type of presentation, deviation in primary position, anomalous vertical movements, face turn, amblyopia and anisometropia. RESULTS: There were 38 (48.7%) affected males and 40 (51.3%) females. Left eye predominance (83.3%) was observed, as was type I presentation (85.9%). Orthotropia was found to be the most common primary position in 46 cases (59.0%). Face turn in unilateral DRS was noted in 13 patients (17.1%). There were 6 cases (7.7%) with anisometropia and 4 (5.1%) with amblyopia. CONCLUSIONS: The clinical manifestations of DRS in our study were different from those of equivalent Caucasian studies yet similar to those previously reported for Asian groups. Racial and regional differences were noted, for which further research is needed to elaborate the reasons and mechanisms.

The Clinical Course of Recurrent Exotropia after Reoperation for Exodeviation

PURPOSE: To determine the clinical course of recurrent exotropia after a secondary operation for exotropia. METHODS: The surgical results in 58 patients who had undergone reoperation for recurrent exotropia (reoperation group) were retrospectively investigated and compared with those of 100 patients who had undergone primary strabismus surgery only (primary operation group) using survival analysis. RESULTS: In the reoperation group, recurrence occurred in 19 of the 58 patients (33%). Survival analysis revealed that the recurrence rates in the reoperation group were significantly lower than those in the primary operation group at the same follow-up period after the corresponding strabismus surgery (p=0.018). The distant esodeviation at the postoperative 1st week after reoperation was the only significant factor associated with the recurrence after reoperation (p=0.01). CONCLUSIONS: Exotropia did recur after a secondary operation, although the recurrence rate was lower than that after a primary operation only.

Thicknesses of Macular Retinal Layer and Peripapillary Retinal Nerve Fiber Layer in Patients with Hyperopic Anisometropic Amblyopia

This prospective study was performed to measure the macular and the peripapillary retinal nerve fiber layer (RNFL) thicknesses using optical coherence tomography (OCT) in patients with anisometropic amblyopia. Thirty-one patients with hyperopic anisometropic amblyopia were included. The macular retinal thickness and the peripapillary RNFL thickness were measured using OCT. The mean refractive error was +3.71 diopters (D) and +1.00 D, the mean macular retinal thickness was 252.5 micrometer and 249.7 micrometer, and the mean RNFL thickness was 115.2 micrometer and 109.6 micrometer, in the amblyopic eye and the normal eye, respectively. OCT assessment of RNFL thickness revealed a significantly thicker RNFL in hyperopic anisometropic amblyopia (P=0.019), but no statistically significant difference was found in macular retinal thickness (P> 0.05). In conclusion, the amblyopic process may involve the peripapillary RNFL, but not the macula. However, further evaluation is needed.

Augmented Surgery for Partially Accommodative Esotropia

The conventional surgery, based on the nonaccommodative angle after full correction of a hypermetropic refractive error, has resulted in a high incidence of undercorrection in the partially accommodative esotropia. In this study, we compared the conventional surgery group (82 patients)to the augmented surgery group (102 patients)in a total of 184 patients.The follow-up period in each group was at least 6 months. Of the 82 patients in conventional surgery group, 55 (67%)showed postoperative deviations of 10 delta or less, 25 (30%)undercorrection, and 2 (3%)overcorrection.Of the 102 patients in augmented surgery group, 81 (79%)revealed postoperative deviations of 10 delta or less, 9 (9%)undercorrection, and 12 (12%) overcorrection.The deviation was improved toward orthotropia by spectacle reduction of less than +2.0 D in overcorrected patients (2 of 2 in conventional surgery group, and 9 of 12 in augmented group).But 3 patients in augmented surgery group remained overcorrected. Our conclusion is that augmented surgery, even if it increase overcorrection, provides better postoperative alignment than conventional surgery in partially accommodative esotropia.

Bicanalicular Silicone Intubation of Canalicular Laceration

Thirty cases of lacerated canaliculi were repaired by bicanalicular silicone intubation(Pilling(R) Intubation Set)with use of a silicone sponge for nasal fixation. The results were as follows: Canalicular laceration occurred mainly in males(25 cases), and in young age group(10-39yrs). An isolated inferior canalicular laceration was the most common and occurred in 23 cases. There was no significant difference in laterality between right and left. The average follow up period was 13.8 months and final results were better in patients who were repaired earlier and had a longer intubation time. Postoperative complications occurred in 7 cases and all of them were canalicular slits. Canalicular slits were not related to the duration of intubation and did not affect the final results significantly. The advantages of this operation were good cosmetic results, minimal irritation by tube, and easy removal of tube.

Two Cases of Adie's Syndrome

Adie's syndrome is characterized by a delayed or diminished direct and consensual reaction to light in a pupil larger than normal associated with loss of tendon reflexes. The authors experienced two female patients at our hcspital whom we feel to have Adie's syndrome and report them with related literature findings.

A Case of Asteroid Hyalitis

Asteroid hyalitis is a condition in which many creamy or dull-white opacities are suspended in the vitreous. The author has recently encountered a case of asteroid hyalitis in a 68 year old Korean woman. The asteroid bodies are small discrete particles, disc-shaped or spherical, sometimes marshalled in strands and columns sometimes in bundles, but more usually showing no roderly arrangement. With the ophthalmoscope, they are seen by reflected light as creamy or white and shiny, looking like snowballs or stars in the night sky. A brief review of the literature is described.

3 Cases of Ocular Toxoplasmosis

The authors have recently experienced 3 cases of ocular toxoplasmosis. The diagnosis was based on typical ocular lesions and hemagglutination test for toxoplasmosis. In addition to some clinical observations, a brief review of literature has been described.

A Case of Malignant Melanoma of the Choroid

The authors have recently experienced a case of malignant melanoma of the choroid in a 34-year-old Korean house wife. The direct ophthalmoscopic finding was characterized by the presence of oval and round shaped, miliary to rice sized dark brown pigments in the surface of detached retina. Histopathologically the tumor cells were spindle B type. There were no extraocular extension and metaetasis. In addition to some clinical observations, a brief review of literature has been described.