Effectiveness of Inferior Oblique Myectomy in Unilateral Superior Oblique Palsy Depending on Magnitude of Hyperdeviation

Purpose@#To evaluate surgical outcome and effectiveness of inferior oblique (IO) myectomy on unilateral superior oblique palsy (SOP) as a primary treatment. @*Methods@#This study is a retrospective review of the medical records of 99 patients who had undergone IO myectomy due to SOP as a first-line treatment. Sixty-five patients with hyperdeviation of 15 prism diopters (PD) or less were categorized into group 1, 22 patients with hyperdeviation between 16 PD to 20 PD into group 2, and 12 patients with hyperdeviation higher than 20 PD into group 3. Preoperative hyperdeviation, postoperative hyperdeviation, and improvement of head tilting were then compared between the 3 groups. Surgery was determined to be successful when the post-op residual hyperdeviation is less than 5 PD, or when the improvement of hyperdeviation and head tilting was noted, for the patients who had preoperative deviation less than 5 PD, and without hypercorrection. @*Results@#All groups showed significant improvement of hyperdeviation, and the amount of correction was larger in group with larger preoperative hyperdeviation. 80.3%, 95.0%, and 90.9% of patients showed improvement of head tiling and success rate was 87.7%, 77.3%, and 50.0% in group 1, 2, and 3 respectively. Group 1 and 2, group 2 and 3 had no significant difference in success rate but only group 1 and 3 had significant difference. @*Conclusions@#Considering success rate with improvement of head position, self-titrating and possibility of overcorrection, IO myectomy could be an effective option as a first-line surgical treatment for unilateral SOP with hyperdeviation of 20 PD or less. However, due to a 50% success rate in patients with hyperdeviation larger than 20 PD, a secondary operation must be considered following IO myectomy, or a two-muscle procedure must be considered as a primary treatment.

Superior Oblique Atrophy on Magnetic Resonance Imaging with Clinical Features in Unilateral Superior Oblique Palsy

Purpose@#To investigate the correlation of superior oblique (SO) atrophy of magnetic resonance imaging (MRI) with clinical features including surgical success in unilateral SO palsy. @*Methods@#This study was a retrospective review of the records of 38 patients who had undergone inferior oblique (IO) myectomy due to SO palsy between January 2017 and March 2019 at our hospital. The patients with more than a 40% decrease of cross-section areas using preoperative orbital MRI were categorized into the atrophic group (16 patients). We compared surgical outcomes between the atrophic and non-atrophic groups. @*Results@#Preoperative IO over-action and vertical deviation showed no significant difference, but the excyclotorsion in paralytic eyes were more frequent in the atrophic group and the surgical success (62.5% vs. 95.5%), and the degree in improvement of vertical deviation (7.17 ± 5.19 prism diopters [PD] vs. 11.05 ± 5.59 PD) was significantly lower in the atrophic group. The degree of SO atrophy showed a weak correlation with the degree of improvement of hypertropia or diopter differences of bilateral head tilting. @*Conclusions@#SO atrophy, detected using preoperative MRI of unilateral SO palsy patients did not show a definite correlation with clinical features except for excyclotorsion in paralytic eyes but did show a clinically significant correlation with surgical outcomes. Preoperative MRI can therefore be used for predicting surgical outcomes of IO myectomy in unilateral SO palsy patients.

Preventive Health Examination, Health Behavior, and Psychological Health in Visual Disabilities

PURPOSE: To better understand visual disabilities via preventative health examination, health behavior, and psychological health. METHODS: The preventative health examination, health behavior, and psychological health records of 4,724 participants over the age of 40 who completed the third Korean National Health and Nutrition Examination Survey (KNHANES III) were analyzed. The participants were divided into 3 groups for analysis: subjects without disabilities, subjects with disabilities but without visual disabilities, and subjects with visual disabilities. The unadjusted mean and the adjusted mean for which socioeconomic factors were adjusted were calculated. RESULTS: In the preventative health examination there were no differences between the 3 groups except for a statistically significant increase in the number of cholesterol check-ups in the visual disability group. In the health-related behavior analysis, lifetime smoking and routine physical activity were similar between the visual disability and no disability group, however, these factors were greater in the disability without visual disability group. The analysis of psychological health revealed that major depressive symptoms, suicidal ideation, suicidal attempts and psychological consultations were greater in the disability without visual disability and the visual disability groups compared to the participants without disability. However the overall number of psychological consultations was low. CONCLUSIONS: There was no difference in the frequency of preventative health examinations between each group. However, there was an increase in the prevalence of psychological problems in subjects with visual disabilities compared to subjects without disabilities and subjects with disabilities but without visual disabilities. Thus, ophthalmologists should consider psychological aspects when dealing with patients with visual disturbances.

Preventive Health Examination, Health Behavior, and Psychological Health in Visual Disabilities

PURPOSE: To better understand visual disabilities via preventative health examination, health behavior, and psychological health. METHODS: The preventative health examination, health behavior, and psychological health records of 4,724 participants over the age of 40 who completed the third Korean National Health and Nutrition Examination Survey (KNHANES III) were analyzed. The participants were divided into 3 groups for analysis: subjects without disabilities, subjects with disabilities but without visual disabilities, and subjects with visual disabilities. The unadjusted mean and the adjusted mean for which socioeconomic factors were adjusted were calculated. RESULTS: In the preventative health examination there were no differences between the 3 groups except for a statistically significant increase in the number of cholesterol check-ups in the visual disability group. In the health-related behavior analysis, lifetime smoking and routine physical activity were similar between the visual disability and no disability group, however, these factors were greater in the disability without visual disability group. The analysis of psychological health revealed that major depressive symptoms, suicidal ideation, suicidal attempts and psychological consultations were greater in the disability without visual disability and the visual disability groups compared to the participants without disability. However the overall number of psychological consultations was low. CONCLUSIONS: There was no difference in the frequency of preventative health examinations between each group. However, there was an increase in the prevalence of psychological problems in subjects with visual disabilities compared to subjects without disabilities and subjects with disabilities but without visual disabilities. Thus, ophthalmologists should consider psychological aspects when dealing with patients with visual disturbances.

Effect of Axial Length (Myopia) on Horizontal Recti Recession in Children with Horizontal Strabismus

PURPOSE: To assess the influence of axial length for surgical outcome of horizontal recti recession in children with horizontal strabismus. METHODS: A retrospective, non-comparative case series. 100 patients, 96 males and 44 females with unilateral or bilateral high myopia and strabismus surgery was performed. All patients had horizontal recti recession and no combined vertical strabismus. There was no history of any ocular trauma or surgery and no history of any other systemic diseases that affect ocular motility. After horizontal recti recession, the patients were followed-up for more than one year. Data was analyzed using SPSS Software for Windows, version 12.0.1. RESULTS: In 100 children, the mean axial length was 23.21 +/- 1.38 mm (range, 19.63-26.50 mm) and the mean age was 7.43 +/- 2.86 years (range, 1-14 years). Lateral rectus recession was in 89 cases, and medial rectus recession was done in 11 cases. After operation, 86 cases were fully corrected, 11 cases were under corrected and 3 cases were over corrected. Binary logistic regression analysis was performed revealing that, preoperative angle of deviation (p-value 0.062) and axial length (p-value 0.05) were highly correlated with surgical outcome. CONCLUSIONS: Age, preoperative angle of deviation, and axial length may influence the surgical outcome of horizontal recti recession in children. In eyes with long axial length, the surgical outcome of horizontal recti recession appears to be poorer than that in eyes with short axial lengths. Adjusting the recession amounts when performing horizontal recti recessions in long axial length eyes may provide better results.

Relationship Between Visual Acuity and Foveation Window in Infantile Nystagmus by Analyzing Nystagmus Waveforms

PURPOSE: To report herein on Nystagmus Acuity Estimator Function (NAEF) based on the foveation time, obtained by analyzing waveforms of infantile nystagmus patients and comparing the results with the patients' actual visual acuity. METHODS: Electro-oculographic data of 27 patients with infantile nystagmus were reviewed. Data of patients only with jerk type nystagmus and reliable visual acuity were analyzed. The foveation time was measured, and NAEF was calculated and compared with the patients' actual best corrected visual acuity. RESULTS: A correlation analysis of the patients' best corrected visual acuity with NAEF was performed, and the retrieved coefficient was 0.4266. The p-value calculated using the Pearson correlation coefficient was 0.0282, implying that high NAEF correlates positively with visual acuity. CONCLUSIONS: Estimated visual acuity, calculated based on the waveforms, positively correlates with the patients' actual visual acuity with statistical significance. However, since the foveation time can be measured only in the patients with jerk-type nystagmus waveforms, further study should be performed on the measurement of the foveation time with other waveforms. Furthermore, the present study shows that such analysis is possible with electrooculogram settings in most general hospitals.

Clinical Manifestations and Surgical Outcome of Infantile Esotropia

PURPOSE: To study the clinical manifestations and surgical outcome of infantile esotropia. METHODS: This review retrospectively examined 165 patients of infantile esotropia who had undergone recession of bilateral medial rectus muscles from April 1991 to September 2001 at our institute. We measured the binocular alignment and analyzed the long term surgical outcome. RESULTS: The average angle of deviation of 165 patients was 45.9 +/- 13.99PD (25 ~ 90PD) and the average refractive error was +sph 1.18 +/- 2.25D (-sph 7.00 ~ +sph 6.00D). Amblyopia was found in 48.4% of the patients, DVD in 12.7%, IOOA in 11.3%, and manifest latent nystagmus in 6.0%. A binocular alignment within 10 PD was achieved in 73.9% and 57.9% at the 2nd and 4th post-operative year respectively. CONCLUSIONS: The surgical outcome of bimedial rectus muscle recession in infantile esotropia was satisfactory in 74%, and 58% of the patients at the 2nd and 4th post-operative year respectively.

Eye Movement Recording using Computer Image Recognition Technique

PURPOSE: To describe that Computer image recognition technique is more accurately and less invasive than other methods, which using contact lens with a search probe or electrodes for record of eye movements. METHODS: A reference marker which was infrared was attached to the center of the forehead of the patients and the infrared light was illuminated to both eyes. Video image sequences were recorded using digital CCD camera and the captured image frames (640 X 480) were processed using a image analysis program. From which each image frame captured, pupil area was saperated using difference of brightness in pupil and iris. And then the pupil center was determined by calculating the center-of-mass of black pixels to meet the pupil threshold criteria. RESULTS: In a post-processing process, we could acquire horizontal and vertical eye position and velocity data. Inverse fast fourier transformation(FFT) and digital filtering algorithm were applied to filter out noise due to limited resolution of the CCD camera and sampling rates. Experimental result showed that the system could detect about 0.2mm positional location and 30Hz horizontal and vertical eye movements simultaneously. CONCLUSIONS: We could accurately measure and record two dimensional eye movements of patients (horizontal and vertical simultaneously) in real time with some head movements.

The Complications Developed after Repeated Botulinum Toxin Injection

PURPOSE: To investigate the incidence of complication associated with repeated botulinum toxin chemodenervation in extraocular muscle. METHODS: 47 patients who had taken botulinum toxin chemodenervation from 1996 to November 2001 were reviewed retrospectively. 10 patients had taken repeated injection. Saline diluted botulinum toxin was directly injected into the extraocular muscle through the Teflon coated needle. RESULTS: In 10 patients, 5 patients had complications which were 2 cases of hypertropia, 2 cases of ptosis and 1 case of retrobulbar hemorrhage who was 44 year old woman taken 5 times of botulinum toxin injection. She was successfully treated with lateral canthotomy and cantholysis. CONCLUSIONS: Rate of complication in repeated botulinum toxin chemodenervation was not different from that of single procedure. We experienced one case of retrobulbar hemorrhage in 10 patients with repeated botulinum injection.

Ocular deviation after unilateral laser in situ keratomileusis

Laser keratomileusis and excimer laser photorefractive keratectomy in situ are widely used therapies for treating myopia. The corrections of refractive error by glasses or contact lens result in a relatively equal refractive correction on both eyes. However, refractive surgery on a single eye can cause a focus disparity between both eyes and may result in the impairment of fusion leading to strabismus. This article aims to report a case where diplopia and esotropia occurred 1 month after laser keratomileusis (LASIK) in situ for the correction of myopia.

Spontaneous Resolution of Infantile Esotropia

Infantile esotropia is an esodeviation with onset before six months of age, characterized by a large stable angle and initial alternation with cross fixation. The natural history of infantile esotropia has not yet been verified. A 39-month-old girl presented with a history of esotropia. She was firstnoted to constantly cross her eyes at three months of age. At the age of five months, she was diagnosed by one of the authors[SHH]to have 25 prism-diopters of esotropia with a low hyperopic refractive error of 0.50D sphere. At that time, she fixed and followed with either eye. Ductions and versions were full. On three more examinations in her first year, she consistently showed 25~30 prism-diopters of esotropia. Against medical recommendation, she did not undergo any surgery. At the age of 39 months, she was found to be orthophoric at distance and at near by another author[JMH]. She could not identify flies or animals in random dot stereograms or Titmus stereograms. At the age of four years, she was still orthophoric at distance and at near. All the ophthalmologic findings remained the same. At the age of five years, she developed exophoria and DVD OS. She still could not identify flies. In conclusion, in rare cases infantile esotropia with a relatively small angle may spontaneously resolve without any treatment.

Functional MRI of Visual Cortex in the Patients with Occipital Lobe Ischemia

PURPOSE: To evaluate the usefulness of functional MRI(fMRI) of visual cortex in patients with ischemic infarction in the occipital lobe. MATERIALS AND METHODS: Four patients with the symptoms and signs of visual cortical ischemia were included. Functional MRI was performed by 2D-FLASH technique with the parameter of 90/56msec TR/TE, 40degrees flip angle, 240x240 FOV, 64x128 matrix number, 8.32 seconds acquisition time, 8mm slice thickness. An axial slice including both visual cortices was selected and alternative activation and resting of the visual cortex was performed using red color photostimulator. All patients undertook visual field test, and vascular abnormality was examined by MRA (n=4) and DSA (n=2). fMRI results were compared with the results of a visual field test, conventional MRI and cerebral angiography. RESULTS: On fMRI, decreased activity of the visual cortex was found in the occipital lobe corresponding to stenosis of the posterior cerebral artery or its branch noted on angiogram. However, 2 of 4 patients showed no abnormal findings on conventional MRI. Visual field defect was noted in 3 patients, one of whom showed no abnormality on conventional MRI and diffusion-weighted image, but revealed decreased activity in the corresponding visual cortex on fMRI. CONCLUSION: fMRI may be a sensitive method for detection of the status of decreased blood flow or vascular reserve which other methods can not.

Neuro-Behcet's disease presenting with isolated unilateral lateral rectus muscle palsy

The authors present the clinical findings of a 30-year-old female and a 29-year-old male who both had isolated unilateral lateral rectus muscle palsy in neuro-Behcet's disease. The clinical feature related to isolated abduscens nerve palsy was identified by CT, systemic assessment and extraocular examination. These patients' constellation of findings appear to be unique: it does not follow any previously reported pattern of ocular manifestations of neuro-Behcet's disease.

Botulinum A Toxin Chemodenervation of Extraocular Muscles

No abstract available.

The Effect of Modified Kestenbum Procedure (6-7-6-7mm) for Abonormal Heal Position in Infantile Nystagmus

We assessed the efficacy of modified Kestenbaum procedure for the correction of abnormal head position in 16 patients with the diagnosis of in fantile nystagmus. Instead of Parks 5-6-7-8mm modified Kestenbaum procedure, we performed 6-7-6-7mm modified Kestenbaum on 11 patients with head turn of 20-30, 20% augmented procedure(7.2-8.4-7.2-8.4mm) on 4 patients with head turn of 30 or more, and-1mm procedure(5-6-5-6mm) on 1 patent with head turn of less than 20. In the average follow-up of 7 months, 10 patients(62.5%) showed head turn of less than 5, in which 14 of 16 patients had less than10 .87.5% of the patients showed satisfactory correction of abnormal head position., 12 prism diopter of exotropia was noted postoperatively in 1 case but the duction was not limited in any case. From the above results, we conclude that 6-7-6-7mm modified Kestenbaum nystagmus.

The Effect of Intraoperative Adjustment Strabismus Surgery Under Topical Anesthesia

The adjustable suture strabismus surgery has been used for the more accurate operation. In general adjustable surgery is a two-stage procedure, so it has many difficulties such as hospitalization, more chances of infection and more times. We performed one-stage intraoperative adjustment strabismus surgery under topical anesthesia and analyzed the result of surgery. 67 patients were included in this study. The patients ranged from 14 to 61 years of age, averaging 27.6 years of age and the follow-up period after operation ranged from 3 months to 58 months averaging 9.4 months. The overall success rate was 78% (52/67). The success rate of reoperation group which had previous one or more strabismus surgery was 63% (5/8). And the success rate of vertically deviated group was 63% (5/8).

Adherence Syndrome After Weakening Procedure of Inferior Oblique Muscle

Adherence syndrome may be due to fibrofatty proliferation creating adherence between infeiror orbital tissue, sclera, or inferior rectus muscle capule and inflammatory reaction initiated by the rupture of the Tenon's capsule and invasion of the extraconal fat. We report 4 cases of adnerence syndrome after weakening procedure of inferior oblique muscle in the cases of overacting inferior oblique muscle.

Surgieal Result of Intermittent Exotropia: Comparison of Sensory Anomaly

In this study, among intermittent exotropia cases, 38 cases indicating sensory anomaly of diplopia and 27 cases indicating sensory anomaly of suppression, and tried to compare the results of operation. Cases of diplopia ranged from 3 years of age to 21 years of age averaging 4.5 years of age, and the follow up period after operation ranged from 2 months to 18 months averaging 6.5 months. The success rate of operation in cases of diplopia was 92%(35/38), and that in cases of suppression was 74%(20/27). Consequently, among intermittent exotropia patiens indicating sensory anomaly the case of diplopia can be said to be higher in the success rate of operation than that of suppression.

Concentration of Tobramycin in the Cornea and Sclera After Subconjunctival Injection of Negatively-charged Liposome Encapsulated Tobramycin in Rabbits

Bacterial keratitis is a common ophthalmic disease. Recently, topical and subconjunctival therapy were equally effective in reducing the number of viable bacteria in experimental corneal ulcers. Subconjunctival injection produced high but transient concentrations followed by persistent low levels. In contrast, eyedrops produced moderate but sustained concentrations throughout the treatment period. Liposomes are small, biodegradable lipid vesicles with an aqueous core. Incorporation of drugs into liposomes provides a convenient way to retard their release from a relatively inert depot without changing the intrinsic characteristics of the agents.