Retinal Detachment after Transscleral Fixation of Posterior Chamber Intraocular Lens

To determine clinical features and outcomes of retinal detachments[RDs] following trans-scleral fixation of posterior chamber intraocular lens[PC-IOL], we reviewed the medical records of 249 eyes[239 patients] which had undergone trans-scleral fixation of PC-IOL and had been followed 6 months or longer. Retinal detachment occurred in 8 out of 249 eyes[3.2%]. The incidences of RDs were as follows:in 2/19 eyes[10.5%] with PC-IOL exchange for PC-IOL tilt, in 1/16 eyes[6.3%] with posterior capsule rupture during ECCE, in 1/26 eyes[3.8%] with ICCE, in 2/78 eyes[2.6%] with posterior capsule rupture during phacoemusification, in 2/106 eyes[1.9%] with aphakia, and in 0/4 eyes[0%] with anterior IOL exchange with PC-IOL. The sites of retinal break corresponded with the directions of needle during fixation in 5/8 eyes[62.5%] and all retinal breaks were located anterior to the equator. The timing of RD was between 2 weeks and 4.8 years after fixation although it occured within 2 months in most cases. Pars plana vitrectomy and scleral buckling were performed in 7 eyes and scleral buckling only in one eye. Retinal reattachment was achieved in seven eyes including three eyes which required two surgical interventions. The vitrectomy should be performed with meticulous care to reduce vitreous traction as much as possible during trans-scleral fixation of PC-IOL and a close follow-up examination for RD is required during the first two months.

The Correction of Corneal Astigmatism Using Piggyback Contact Lens

We evaluated the effects of piggyback contact lens that override the hard contact lens over soft contact lens for irregular astigmatic correction. Two patients received corneal suture for corneal laceration and one patient received penetrating keratoplasty for Francois dystrophy. The uncorrected visual acuity was counting fingers at 20cm, 0.05, and 0.08, respectively and corrected visual acuity using glasses or conventional contact lens was 0.1, 0.2, and 0. 2, respectively. The difference of keratometry reading between two meridians is 6, 7.5, and 12.5 diopters, respectively. The visual acuity after piggyback contact lens fitting was 0.4, 0.9, and 0.3, respectively. The complication such as corneal ederna, corneal erosion, and neovascularization of cornea was not noted during 24 months after piggyback contact lens fitting. The piggyback contact lens fitting inay be an effective method of correcting visual acuity for irregular astigmatism.

The Effect of Absorbable Cellulose(Interceed, TC7) in Prevention of Adhesion in Strabismus Surgery in Rabbits

The formation of adhesion following strabismus surgery may result in restrictive ocular motility dysfunction. We performed conventional recessions of both inferior and superior rectus muscle in right eyes of 11 white rabbits as control group and a sheet of 2 x 2 mm absorbable cellulose(Interceed, TC7) was inserted between rectus muscle and conjunctiva in left eyes of 11 rabbits as interceed group in the hope of preventing postoperative adhesion. We examined conjunctival injection, corneal abrasion, scleral necrosis and discharge at 1st, 2nd day, 1st, 2nd, 4th, 6th week following surgery and examined muscle adhesion powers by spring gauge and degrees of adhesion by blunt disection and histopathologic examination with light microscope at 6th week. The postoperative corneal and conjunctival findings and muscle adhesion powers were similar but degrees of adhesion at both blunt dissection and histopathologic examination revealed statistically significant reduction of adhesion in absorbable cellulose group than control group. From these findings, it would appear that the use of absorbable cellulose is effective in preventing postoperative adhesion following strabismus surgery .

The Effect of Anterior Transposition of the Inferior Oblique Muscle with Marginal Myectomy in a Case of Lost Inferior Rectus Muscle

Although a patient with lost inferior rectus (IR) muscle woud be done infratransposition of the horizontal recti to control hypertropia, this procedure only could control ocular deviation at primary position, but could't improve the limitation of the downgaze markedly and could cause limitation of abduction and adduction. Authors tried to correct lost IR with anterior transposition of the inferior oblique muscle(IO) with marginal myectomy in the theoretical base that the anterior transposition of the IO can convert IO a depressor from an elevator. A 66 year-old female patient received trauma on her left IR muscle by sickle, then primary deviation of left eye was hypertropia of 50 prism diopters, exotropia of 35 prism diopters and secondary deviation was hypertropia 60 prism diopters, exotropia of 40 prism diopters and the degree of limitation of infraduction was -4. We performed anterior transposition of the IO with marginal myecctomy of 6.0 mm and lateral rectus (LR) 6.0 mm recession and medial rectus (MR) 4.5 mm resection of the left eye. The postoperative ocular alignment at primary position was exotropia of 10 prism diopters and degree of limitation of infraduction was -2 and limitation of supraduction was -2. The anterior transposition of IO with marginal myectomy was simple and effective in correcting the hypertropia and ocular motility in a case of lost IR.