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.

Research on Ocular Fatigability Induced by Multimedia and Instrument Features

PURPOSE: The aim of the present study was to evaluate the different features of such instruments and how they cause ocular fatigability. METHODS: Under the same settings and circumstances, 75 participants were asked to read the novel, "You without me?" in different formats including paper book, E-book (biscuit(R), Interpark Inc., LG INNOTECK LTD, Korea) and LCD reader (iPad(R), Apple Inc., United States). For every 10 minutes of reading, 10 minutes of rest was provided. After finishing the novel, the participants were asked to complete a questionnaire, and the data obtained were statistically analyzed using univariate analysis. RESULTS: Compared to paper book readers (1.93), LCD readers (2.40) complained of insufficient lubrication in the eye (p = 0.038), and experience more letter-floating illusions (1.92) than did paper book readers (1.49) (p = 0.043). Moreover, compared to the other formats including the E-book (20%) and paper book (8%), LCD readers (72%) experienced more significant glare symptoms (n = 23) and could read at a faster rate than the other groups of readers (n = 26). CONCLUSIONS: In the present study, the I-Pad caused ocular fatigability more easily than the other formats examined. No statistical significance of ocular discomfort or fatigability was observed among the different format groups. Further investigation with a greater number of age-controlled participants should be conducted prior to designing a study to determine the best format for reading.

Attempts to Reduce the Progression of Myopia and Spectacle Prescriptions during Childhood: A Survey of Eye Specialists

PURPOSE: To determine methods tried in clinical trials to reduce the progression of myopia in children, and spectacle prescribing patterns of hospital ophthalmologists. METHODS: A multi-sectioned survey composed of Likert items relating to the methods of reducing myopia progression (orthokeratology lenses [O-K lenses], undercorrected glasses, and topical atropine) and the patterns of prescribing spectacles for children (including two cases involving a 5-year-old girl and an 8-year-old boy) were distributed to members of the Korean Ophthalmological Society, and the collected data was statistically analyzed. RESULTS: A total of 78 out of 130 ophthalmologists returned the survey. On a scale of 1 to 5, the mean rates of whether the ophthalmologists think O-K lenses arrest myopia progression, and whether they recommend their patients to wear O-K lenses if indicative, were 3.06 and 2.75, respectively. Moreover, the mean rates of whether they consider that wearing glasses which are undercorrected would slow down the progression of the myopia, or if they think topical atropine helps in arresting myopia progression in children, were 2.34 and 1.27, respectively. In response to the case studies, the majority of practitioners preferred to prescribe the full amount found in cycloplegic refraction to pediatric patients with myopia. CONCLUSIONS: Ophthalmologists in clinical practice encouraged children to wear O-K lenses more than undercorrected glasses as a way to retard myopia progression. However, the application of atropine is rarely tried in clinical trials. In managing pediatric patients with myopia (case specific), the majority of the practitioners chose to prescribe glasses with full cycloplegic correction.

Effect of Muscle Relaxants on Short-term Results of Exotropia Surgery: A Focus on Resection Procedures

PURPOSE: We investigated the effect of muscle relaxants (atracurium) on the outcomes of intermittent exotropia surgery under general anesthesia, with a focus on resection procedures. METHODS: Thirty four patients who underwent recession and resection (R&R) were divided into two groups: atracurium usage (group A, n=18) and no atracurium usage (group B, n=16). Patients were divided into two subgroups according to the amount of resection of the medial rectus (MR): less than 5 mm (group 1, n=13) or 5 mm and greater (group 2, n=21). Deviation angles were compared between groups and subgroups. Surgical outcome was defined as successful if distant deviation angles were equal to or less than 10 prism diopters. RESULTS: The overall postoperative deviation angles did not show statistically significant differences between groups A and B. However, in patients with larger MR resections (> or = 5 mm), the 1 week postoperative distant deviation was significantly larger in group A (1.8+/-2.6 PD) than in group B (-1.6+/-4.6 PD, p=0.048 by t-test). The overall undercorrection rate at 3 months postoperatively for group A was 16.7%, which was higher than that of group B (6.3%), and the difference was even larger in subgroups with larger MR resections (> or =5 mm): 18.2% in group A and 0% in group B. CONCLUSIONS: Patients who underwent R&R procedures under general anesthesia with a muscle relaxant tended to be less corrected than those without muscle relaxant, especially in the early postoperative period and with a larger MR resection equal to or greater than 5 mm. However, there was no significant difference in the later postoperative period.

The Operation of Unaffected Normal Eye in Unilateral Ptosis

Moderate to severe unilateral ptosis has previously been treated with levator resection or frontalis sling and cosmetic double fold in the opposite eyelid. This method often resulted in undesirable asymmetrical lid lag phenomenon in down gaze. From December 1991 to December 1994, we treated 65 cases of unilateral ptosis with frontalis sling or levator resection, and simultaneously cosmetic frontalis sling have been performed in the unaffected normal eyes of 41 patients and cosmetic double fold have been performed in the unaffected normal eyes of 11 patients. After 6 months of operation, authors survey the patients content. The number of cases of content were 4(36.36%) in 11 cosmetic double fold group and 31(75.6%) in 41 cosmetic frontalis sling group. The content after cosmetic frontalis sling was higher than cosmetic double fold. Asymmetrical lid lag phenomenon on downward gaze which is inevitable complication postoperatively was reduced by means of cosmetic frontalis sling of unafeected normal eye in unilatral ptosis. The authors expect that the patient will be more satisfied with the result of symmetrical lid lag in down gaze after cosmetic frontalis sling of unaffected normal eye in aesthetic aspect.

Electroretinogrophic Finding of the Stargardt's Ddosease

Stargardt's disease is a heredo-macular dystrophy which evidences itself by reduced visual acuity, bilaterally, slowly progressive lesion, and by color blindness starting in youth. The diagnosis of Stargardt's disease is usually made by biomicroscopy and fluoresceine angiography which show many irregular shaped, small yellowish flecks. According to Fishman, the characteristic prolonged time to obtain adequate rod amplitude in dark-adapted electroretionography is advisable for differential diagnosis of Stargardt's disease. We didn't find the abnormal finding of dark-adapted electroretinography in two patients of Stargardt's disease. So, more studies will be needed for electroretinography of Stargardt's disease.

A Case of Neurofibroma of the Orbit and Pterygopalatine Fossa

In neurofibroma, not only schwann cells but also perineural cell, endoneural cells, and fibroblastoid cells create the tumor mass. Simple, isolated neurofibroma are common in the skin but rare in the eye. Simple isolated neurofibroma of the eye are common in the superior orbit, and a case with an isolated neurofibroma of the orbit and maxillary antrum has been reported. The authors have experienced a 57-year-old male patient who complained exophthalmos on his left eye for 2 years. The neurofibroma of the orbit and pterygopalatine fossa was confirmed and reported with a review of literature.

Study on the Temperature Measurement in the Newborn Infants

No abstract available.

Treatment of Retinal Detachments by Pneumatic Retinopexy

Pneumatic retinopexy is a recently described procedure to treat the uncomplicated retinal detachment. The procedure of pneumatic retinopexy is composed of cryotherapy (or laser photocoagulation), intraocular gas injection and postoperative positioning. The advantages of pneumatic retinopexy are less tissue trauma, no hospitalization and minimal complication. For these reasons it is more and more popular, but further studies are needed to assess its ultimate safety and efficacy. The authors experienced 7 cases of primary rhegmatogenous retinal detachment treated with pneumatic retinopexy, from September, 1987 to March, 1988. Four cases of the retinal detachment were successfully reattached after pneumatic retinopexy. In the other 3 cases, new retinal tear and detachment were found after pneumatic retinopexy, which were successfully repaired with the conventional scleral buckling procedure.