The Effect of Minimal Amount Inferior Oblique Recession in Superior Oblique Palsy

PURPOSE: To investigate the effect of vertical deviation change, head tilt and diplopia relief, we performed a minimal amount of inferior oblique recession regardless of the vertical deviation angle and the degree of inferior oblique overaction (IOOA) in superior oblique palsy patients. METHODS: We retrospectively analyzed 20 cases of unilateral congenital or acquired superior oblique palsy, which were treated with inferior oblique muscle recession from May 2005, to August 2007. We compared vertical deviation change, head tilt and diplopia relief following surgery. Improvement of head tilt was determined by patient satisfaction measurements. The inferior oblique muscle was attached 4 mm posterior and 2 mm temporal to the lateral border of the inferior rectus muscle insertion in all patients. RESULTS: The average angle of vertical deviation prior to surgery was 12.4 prism diopters (PD), and the total average correction in the angle of vertical deviation after surgery was 9.6PD. After surgery, head tilt improved in 13 of 16 eyes(81%), and of the four remaining eyes, vertical diplopia was absent. CONCLUSIONS: Although vertical deviation remained after surgery, if patients have enough vertical fusional amplitude, they should be able to overcome the diplopia and the head tilt. Judging from the indication of inferior oblique recession in diplopia and cosmetic problem in superior oblique palsy, a minimal amount of inferior oblique recession is thought to be an effective treatment of unilateral superioroblique palsy with no significant IOOA.

Results of Surgical Treatment for Paralytic Strabismus

PURPOSE: To study the correction effects of standard recession and resection in paralytic strabismus excluding superior oblique palsy. METHODS: Eighteen cases of paralytic strabismus treated by standard recession and resection from March 2005 to October 2007 were retrospectively analyzed. RESULTS: The average angles of deviation before surgery and after surgery were 55 prism diopters (PD) and 12PD, respectively. Adjustable suturing was performed in 12 cases. The diplopia was improved in 14 out of 18 cases (77%) after surgery. Three cases of the -4 grade paralyzed group had a large residual deviation after surgery. The success rate was 78% (14/18) when success was defined as a residual deviation of less than 15PD. Severe ocular motility limitation (-4 grade) group was less affected than other groups. In the below -3 grade paralyzed groups, patients resolved diplopia in the primary eye position, and did not complain of diplopia by incomitance in the secondary eye position. CONCLUSIONS: Standard recession and resection may actively be attempted in below -3 grade paralytic strabismus patients to resolve diplopia in the primary eye position.

A Case of Congenital Inferior Oblique Palsy

PURPOSE: Paresis of the inferior oblique is the least likely to result in paralysis. We report a patient without a history of trauma successfully treated using contralateral IO recession and SR recession. CASE SUMMARY: A 25-year-old male patient presented to us with an extended history of abnormal head posture, manifested by a marked habitual left head tilt with a face turn to the right. A cover test in the primary position demonstrated 15 prism diopter right hypertropia, which increased to 25 prism diopter right hypertropia in right gaze and 20 prism diopter right hypertropia in right head tilt. The patient was diagnosed with IO palsy, and a right IO recession was performed. RESULTS: Following the IO recession, head tilt was completely resolved and face turn to the right was slightly resolved. Cover test in the primary position demonstrated 12 prism diopter right hypertropia, which increased to 20 prism diopter right hypertropia in right gaze. A head tilt test demonstrated a symmetrical 12 prism diopter right hypertropia. We performed a right SR recession to decrease face turn and hypertropia in the primary position. CONCLUSIONS: We report a patient manifesting abnormal head posture diagnosed with IO palsy, which was successfully treated using contralateral IO recession and SR recession.

A Case of Dislocation of the Globe into the Maxillary Sinus after Orbital Wall Fracture

PURPOSE: We report a case of a 38-year-old man who suffered a blowout fracture of the orbital wall with an intact eyeball entrapped within the maxillary sinus after trauma. CASE SUMMARY: The 38-year-old man was admitted to the emergency room after sustaining a work-related trauma. His chief complaints were loss of vision and bleeding from the left periorbital area. He had no light perception and no eyeball was found in the orbit. Facial CT revealed that the intact eyeball was entrapped within the maxillary sinus. The condition of the optic nerve was difficult to ascertain. Ten hours after post-trauma, reduction surgery was done with a graft from the iliac bone. Ruptured extraocular muscles were not primarily sutured. After four months, vitrectomy was performed on the left eye. The eyeball was repositioned in its place. He had no light perception. Extraocular motility improved at the last follow-up examination. CONCLUSIONS: We report the dislocation of the eyeball globe into the maxillary sinus after a blowout fracture. Visual acuity showed no light perception as a result of central retinal artery occlusion and optic nerve injury. We were able to obtain a good aesthetic and functional result after the operation.

Multifocal Electroretinography After Reattachment of Macula-Off Retinal Detachment

PURPOSE: To assess macular function by multifocal electroretinography after reattachment of macula-off retinal detachment and to evaluate relationship between duration of macular detachment (DMD) and functional recovery. METHODS: Nineteen patients (19 eyes) with macula-off rhegmatogenous retinal detachment underwent pneumatic retinopexy or scleral buckling. Retinal reattachment was obtained successfully in all patients. Duration of follow-up of all patients is at least more than 12 months. Eyes were divided into 2 groups, corresponding to the DMD : Group A (within 7 days, n=9 eyes), Group B (>7 days, n=10 eyes). The amplitudes and implicit times of N1-wave and P1-wave of mfERGs in Area 1 (Ring 1), Area 2 (Ring 1+2) were compared between Group A and B and between Group A and control group. RESULTS: The P1 amplitudes in Area 1 and 2 were significantly different between Group A and B (P0.05). There were no significant difference of all data between Group A and control in Area 1 and 2 (P>0.05) The implicit times of N1, P1 were not significantly different between Group A and B. CONCLUSIONS: The DMD plays a key role in recovery of visual function after reattachment. The mfERG is a useful tool to evaluate the recovery of macular function after reattachment of macula-off retinal detachments.

Biometric Comparisons between Acute and Chronic Angle Closure Glaucoma

PURPOSE: The purpose of the study was to find any difference of biometric features between acute angle closure glaucoma and chronic angle closure glaucoma. METHODS: A survey was conducted on glaucoma patients who visited the outpatient department between Jan 1, 1995 and May 31, 2001. We performed biometric measurements such as axial length, lens thickness, anterior chamber depth, and lens thickness/axial length in 48 patients with primary angle closure glaucoma who were previously done with laser iridotomy or trabeculectomy on both eyes. They are consisted of 24 patients of acute angle closure glaucoma, 24 patients of chronic angle closure glaucoma and 24 normal controls. RESULTS: This study attempted to determine morphological factors which may cause acute attack of primary angle closure glaucoma by comparing biometric features between chronic angle closure glaucoma and acute angle closure glaucoma, but the authors could not find any differences in the biometric features (lens thickness, axial length, anterior chamber depth) which may give rise to the acute attack. CONCLUSIONS: In the acute attack group and chronic angle-closure glaucoma group, there was no significant difference in biometric factors such as lens thickness, axial length, anterior chamber depth and ratio of lens thickness to axial length. Such result leads to the assumption that complex of biometric factors may give rise to acute attack. There's the need for further study with regard to morphological factor which gives rise to the acute attack.

A case of erosive vitreoretinopathy

Hereditary vitreoretinopathies are potentially blinding inherited disorders characterized by an abnormal-appearing vitreous gel and associated retinal changes. Four of these disorders, Stickler's syndrome, Wagner's disease, erosive vitreoretinopathy, and Goldmann-Favre syndrome, exhibit marked syneresis of the vitreous gel. Erosive vitreoretinopathy has associated retinal pigment epithelial changes, poor night vision, visual field defects, and abnormal electroretinographic findings; symptoms not found in Stickler's syndrome. A 36-year-old man with progressive visual loss and a visual field defect had no systemic disease. His vitreous cavity was liquefied. Vitreous strands and a cataract were found in both eyes. Pronounced RPE degeneration was found superotemporally in both eyes and a bullous rhegmatogenous retinal detachment in the left eye accompanied two retinal tears. His visual field showed a ring scotoma in both eyes and the ERG finding was abnormal. We report one case of erosive vitreoretinopathy with retinal pigment epithelial changes, rhegmatogenous retinal detachment, visual field defects, abnormal electroretinographic findings, marked vitreous syneresis and cataract. These symptoms are distinct from previously described entities.

A Case of the Neuromyelitis Optica (Devic's syndrome)

Neuromyelitis optica is a rare demyelinating disorder of unknown etiology in which unilateral or bilateral optic neuritis and transverse myelitis occur within few days or weeks time interval.It is a disorder that occurs more commonly in children than in adult. The authors experienced a case of neuromyelitis optica in a 10-year-old male who developed acute visual loss of both eyes, pain and sensory loss of both legs, paraplegia, and urinary difficulty. We confirmed this case by neurologic feature, magnetic resonance imaging, cerebrospinal fluid findings, and visual evoked potential.His symptoms improved with systemic corticosteroid therapy. Therefore, we report our case with a review of related literature.