Adjustable Suture Technique in Pediatric Strabismus with Ketamine Anesthesia

Adjustable suture technique may be indicated for strabismus surgery when the surgical outcome will be uncertain. We used ketamine intramuscular injection for sedation the day, and performed adjustment after the surgery to enhance the postoperative success rate. The results were analyzed. The average age of the 29 pediatric patients was 53.5 +/-21 months and they were devided into 22 exotropia group and 7 esotropia group. The minimal postoperative observation period was 3 months(average 4.2+/-1.6 months). Among 22 exotropia patients, 13 patients were adjusted and the advancement amount was 1~2 mm. Esotropia was not adjusted. In the final follow-up evaluation, 19 exotropic patients(86.4%)and 7 esotropic patients showed the favorable outcome. However, 3 exotropic patients failed. Two were overcorrected and 1 was undercorrected. In 1 overcorrected case, the postoperative V pattern esotropia occurred. When the alignment can be measured and the picture of external eyes can be obtained, postoprative adjustment was possible after ketamine intramuscular injection. Since the degree of preoperative alignment and the precise evaluation of preadjustment alignment play an important role in determining the advancement amount, careful evaluation should be performed.

Comparison between New Threshold Visual Field Strategy, SITA-standard and Full Threshold Strategy and Their Clinical Us efulness

We compared the full threshold method, central 30-2 Humphrey perimetry with a newer strategy of SITA-standard.To valuate the clinical usefulness, 30 glaucoma patients and 20 normal persons underwent both tests. MD, PSD and test time were comparatively analyzed.In glaucoma patients, the mean test time was 7 min 37 sec[+/-1 min 54sec]for the SITA-standard, while it was 14 min 55 sec[+/-1 min 58 sec]for the full threshold method.The mean value of MD were -7.62 +/-7.93 and 8.85 +/-8.19, while PSD were 5.89 +/-4.24 and 6.50 +/-4.07, repectively. In normal persons group, the mean test time was 6 min 56 sec[+/-1 min 3sec]for the SITA-standard, while it was 14 min 1 sec[+/-1 min 24 sec]for full threshold method.The mean values of the MD were -2.41 +/-0.87 and 3.00 +/-1.31, while the mean values of the PSD were 2.04 +/-0.47, 2.12 +/-0.50, respectively. In conclusion, the SITA-standard did not show any significant differences in both MD and PSD.However, the test time was reduced 49%in glaucoma patients and 53%in normal persons.Therefore, the SITA-standard exhibited similar clinical significance on both glaucoma patient and glaucoma suspect.So it was an useful and effective test to reduce test time.

A Histopathological Study on the Production of Exfoliation Material in Eyes with Exfoliation Syndrome

The hallmark of exfoliation syndrome is the appearance of white granular deposits and dandruff-like flakes on the lens,iris and angle. The incidence of glaucoma is high,and due to zonular weakening, complications are likely to occur in cataract surgery. A histopathological study with electron microscopy was performed on the iris and conjunctival tissue in order to clarify the production process of exfoliation material in the eyes with exfoliation syndrome. The materials were obtained from 13 eyes with exfoliation syndrome during surgery for glaucoma or cataract. The clumps of microfibrils were observed in the extracellular matrix, and the exfoliation materials were closely related with microfibrils.It was found that the basic unit of the exfoliation materials was microfibril. The cellular degenerations were observed in the basement membrane of capillary endothelium, especially the cells near the iris vessels. The exfoliation materials were observed around the degenerated cells; the mature or immature exfoliation materials around the iris melanocyte which show the various degrees of degeneration. The more degeneration and melting of the cells, the larger amount of exfoliation materials. This study suggests that the exfoliation materials in the eyes with exfoliation syndrome are derived from the abnormal microfibril, abnormal basement membrane, and degenerated cell itself.