Anterior Transposition of the Inferior Oblique Muscle for Dissociated Vertical Deviation Associated with Inferior Oblique Muscle Overaction

We analyzed the surgical results of 9 eyes in 7 patients who had undergone the anterior transposition of inferior oblique muscle for correction of dissociated vertical deviation(DVD) with inferior oblique overaction from April, 1990 to February, 1992. The follow up periods were at least more than 6 months. In cases of upward deviation angle were less than 16 delta, we have done transposition of the inferior oblique muscle to just temporal insertion of inferior rectus muscle, and in cases of upward deviation angle were more than 16 delta, the inferior oblique muscle was transpositioned to 1mm anterior position of the just temporal insertion of inferior rectus muscle. Average reduction of DVD in method A(5 eyes in 4 patients) was 9.2 delta, average reduction of DVD in method B(4 eyes in 3 patients) was 10.2 delta. As for postoperative complications, mild upgaze limitation was observed in all cases and one case of "V" pattern exotropia and one case of protrusion of lower eyelid were observed at extreme upgaze position. Therefore, anterior transposition of inferior oblique muscle for correction of dissociated vertical deviation(DVD) with inferior oblique overact ion can considered as a good method to remove the postoperative manifest vertical deviation.

Surgical Result of Vitrectomy in Ocular Trauma

We reviewed 49 patients(50 eyes) who had undergone pars plana vitrectomy for the traumatized eyes during the last 4 years. We divided patients into 4 groups according to the characteristics of ocular injuries-anterior segment Injury, posterior penetrating injury, intraocular foreign body and blunt injury. We analyzed surgical results and compared surgical outcomes according to timing of vitrectomy performed(within 2 weeks VS more than 2 weeks after trauma). Anatomical success was achieved in 36 eyes(72.0%) and functional success was achieved in 23 eyes(46.0%). The main causes of functional and anatomical failure were macular pucker and phthisis bulbi respectively. The anatomical and functional success rates were higher when vitrectomy was performed within 2 weeks after trauma. In posterior penetrating injury group, however, anatomical success rate was lower when vitrectomy was performed more than 2 weeks after trauma. The frequency of retinal detachment was higher when vitrectomy was performed more than 2 weeks after trauma. In cases of intraocular foreign body, retinal detachments were developed in all patients after vitrectomy performed more than 2 weeks after trauma. If vitrectomy is required for patients with ocular injury, we suggest vitrectomy within 2 weeks after frauma for better chance to perserve the globe and for salvaging vision.

A Clinical Study of Cause of Unilateral Exophthalmos

We reviewed the charts of 39 patients had a exophthalmos of 2mm or more than the sound eye by Hertel's exophthalmometer during the last 5 years retrospectively. We attempted to analyze the causes of exophthalmos and the correlation between its causes and degree of exophthalmos, visual acuity, extraocular muscle motion limitation and fundus changes. The most common cause of unilateral exophthalmos was orbital tumor(14/39, 36%), the degree of exophthalmos in orbital tumor showed a tendency to be greater than that of other causes. In orbital tumor patients, extraocular muscle motion limitation and fundus changes also shows a higher tendency than the others. Among unilateral exophthalmos patients, if the degree of exophthalmos, fundus changes and extraocular muscle motion limitation shows moderate or over, it may strongly suggest that the cause is orbital tumor. And also, it is important to cooperate with other departments, especially otorhinolaryngology, in diagnosis and treatment of unilateral exophthalmos patients.