Astigmatism after Cataract Surgery using Various Wound Sizes, Configurations, and Suture Techniques

We performed a retrospective review of three hundred and twelve consecutive patients who underwent phacoemulsification and posterior chamber lens implantation between January 1, 1990 and December 31, 1990. Patients were divided into three groups according to the wound size: 3.5 - 4.0 mm(95 patients); 5.0 - 5.5mm(74 patients) and 6.5 - 7.0mm(143 patients). The patients in the 3.5 to 4.0mm did not receive suture and the patients in the 5.0 to 5.5mm wound size received one horizontal suture. The patients in the 6.5 to 7.0mm group were further evaluated by comparing those who received two horizontal sutures with those who received a running shoelace suture. At one day, one week, one month, and one year after surgery, astigmatic error was measured and a vector analysis calculation of diopters of mean induced keratometric astigmatism was performed. There was a statistically significant increase in astigmatism following 6.5 to 7.0mm incision as compared to 3.5 to 5.5mm incision at each time interval. There was no significant difference in astigmatism at any time period between the 5.0 to 5.5mm and 3.5 to 4.0mm incision groups. The longer the incision, the greater the postoperative against-the-rule astigmatic shift at the last follow up. Among those of 6.5 - 7.0 wound size, the shoelace suture technique induced greater with-the-rule astigmatic change than two horisontal sutures at postoperative day one but the difference did no longer persist at one year.

Prevention of Adhesion Syndrome after Extraocular Muscle Surgery in Rabbit

Several high molecular weight polymers were tested as a barrier against adhesion between extraocular muscle and its surrounding tissue in a rabbit. We used 48 rabbits to investigate the efficacy of hyaluronic acid, methylcellulose, and gel form as compared to balanced salt solution as a control group in reducing the postoperative adhesion. Under general anesthesia, superior rectus muscle was detached and reattached to original insertion site after coating with barrier materials. Rabbits were killed and histologic examinations were done for degree of adhesion formation at 1. 2, 3, and 6 weeks after surgery. The results were as follows; 1. In control group, the portion that showed the most severe fibrosis was within muscle itself and the portion of the least fibrosis was between muscle and sclera. But in experimental group, there was no differences in degree of fibrosis according to operation site. 2. In control group, the fibrosis progressively increased during the postoperative 6 weeks. In hyaluronic acid group and methylcellulose group, the fibrosis decreased from postoperative 1 week and the degree of decreased fibrosis was more evident in methylcellulose group. In gelform group, fibrosis decreased until postoperative 3 weeks and then increased at postoperative 6 weeks. And one case of foreign body reaction was noted in gel form group. The above results suggest that high molecular weight polymers such as hyaluronic acid and methylcellulose are effective in prevention of adhesion syndrome after extraocular muscle surgery and that methylcellulose is more effective compared to hyaluronic acid.

Sturge-Weber Syndrome with Congenital Ocular Anomaly

Sturge-Weber syndrome is a rare congenital anomaly which includes facial port-wine stains with ipsilateral intracranial, hemangioma, ipsilateral choroidal hemangioma, and congenital glaucoma. The syndrome is thought to result from dysmorphogenesis of cephalic neuroectoderm. We report a case of Sturge-Weber syndrome combined with congenital ocular anomaly such as phthisis bulbi, corneal opacity, and iris anomaly.

Lid Splitting and Posterior Lamellar Cryosurgery for Congenital Distichiasis

Congenital distichiasis is a rare condition in which accessory row of lashes is present in place of the Meibomian gland orifice. These aberrent ciliae irritate the cornea and conjunctiva and therefore cause epiphora, photophobia, conjunctival injection, corneal erosions, and may develop into opacification. All four patients from the same family who had anomalous row of lashes in their eyelids complained of the same persistent ocular irritation along with strabismus and ptosis. We performed, on all of the four patients, lid splitting along the gray line and cryotherapy to the posterior lid lamella where the follicles of aberrent ciliae are located, and excised redundant skin of upper and lower lids. By these operations, all four patients showed improvement in their ocular irritaton. We report clinical presentation of four patien~s of congenital distichiasis and believe lid splitting and cryosurgery is effective method for congenital disti chiasis.