A Case of Surgical Repair in Strabismus Fixus with Ptosis

Strabismus fixus is very rare and the convergent form is rarely accompanied by blepharoptosis. We successfully treated one patient with high myopia whose convergent strabismus fixus, accompanied by blepharoptosis, became severe after cataract surgery. We report the case with a discussion of its pathology. We performed levator advancement operation, bilateral lateral rectus 11 mm resection, and bilateral medial rectus 8 mm recession. The suture was removed after maintaining temporary traction suture for 6 days. Blepharoptosis was completely corrected by postoperative 2 months. Esodeviation was 15PD, which was not increased compared with immediately after surgery. Satisfactory cosmetic outcome was obtained.

The Effect of Intravitreal Triamcinolone Acetonide on Intraocular Pressure

PURPOSE: To Investigate the effect of intravitreal triamcinolone acetonide on intraocular pressure (IOP) and the risk factors for its elevation. METHODS: This retrospective case study comprised 25 patients (26 eyes) with diabetic macular edema and 7 (7 eyes) with retinal edema due to branch retinal vein occlusion. The IOPs before and after intravitreal injection of 4 mg triamcinolone acetonide (postoperative 2 hours, 1 day, 2, 4, 8, and 12 weeks and 6 months) were recorded by Goldmann applanation tonometer. RESULTS: The average time to maximum IOP was 3.9 weeks and the difference of maximum post-injection IOP and pre-injection IOP was statistically significant (P<0.0001). IOP at post-injection 2 hours and 8 weeks was elevated significantly (p=0.01 and p=0.028, respectively). During follow up of 6 months, 8 eyes (24.24%) demonstrated an increase in IOP of 5 mmHg or greater, and 4 eyes (12.12%) of 10 mmHg or greater. IOP was more elevated in BRVO, younger age (< 60years) and males. All eyes responded to topical glaucoma medication. CONCLUSIONS: Transient IOP elevation can develop after intravitreal triamcinolone injection, especially from 4 to 8 weeks. Patients with risk factors for the elevation of IOP should be observed closely.

Retinal Angiomatous Proliferation

PURPOSE: To report the cases of retinal angiomatous proliferation (RAP) which has been known to be rare in Asian populations, and to describe the characteristic clinical and angiographic findings of RAP. METHODS: Six eyes of 3 patients were diagnosed as having RAP, and 5 eyes had extensive soft drusen. The first case showed intraretinal neovascularization (RAP stage 1) and subretinal neovascularization with a retinal-retinal anastomosis and an associated serous pigment epithelial detachment (RAP stage 2). The second case showed choroidal neovascularization with a retinal choroidal anastomosis (RAP stage 3) and RAP stage 1. In the third case, RAP stage 2 and severe fibrous scarring, resulting from RAP, could be found. RESULTS: RAP seems to have the tendency for bilateral involvement and extrafoveal location, and a high index of suspicion may be required in the eyes having large serous pigment epithelial detachment accompanied by soft drusen. Fundus findings, such as intraretinal or preretinal hemorrhage, intraretinal reddish nodule, macular edema and indocyanine green angiogram findings of retinal-retinal anastomosis or retinal-choroidal anastomosis, have diagnostic values.