New Technique of Anterior Chamber Tube Shunt to an Eneircling Band for Refractory Glaucoma

New techniques of anterior chamber tube shunt to an encircling band (ACTESB) were used in 49 eyes of 47 patients with neovascular glaucoma and other types of refractory glaucoma. In 34 eyes of 33 patients (Group A), by using Isingle slit incision and end suturing technique at the distal portion of tube, intraocular bressure was controlled less than 21mmHg in 21 eyes (61.8%) with a follow-up of 6 months to 18 months (mean, 13 month). The mean intraocular pressure of 36.38mmHg was reduced. Visual acuity was maintained or improved in 61 %. In 15 eyes of 14 patients (Group B), by using multiple slit incision at the distal portion of tube and single slit incision of the tube beneath scleral flap and external occlusion of tube with 8-0 vicry1, successful outcome was obtained in 86.6% of eyes after average follow up of 6 months. The mean intraocular pressure of 41.47mmHg reduced. Visual acuity was maintained or improved in 86.8%. The incidence of flat anterior chamber was decreased markedly and hyphema was not found in group B. In 4 eyes, there was evidence of blockage of the distal end of tude. Thus we think that the pattern of one piece valved implant is better than the other technique.

Neuro-ophthalmologic Evaluation of the Third, Fourth and Sixth Cranial Nerve Paralysis

A series of 250 patients with paralysis of the third, fotrth and sixth cranial nerves, who were diagnosed at Kyung Hee University Hospital, was analyzed. All patients with a neuroophthalmologic problem who visited the Dept. of Ophthalmology or had a consultation from another were included. There were 116 cases(46.4%) of sixth nerve paralysis, 88 cases(35.2%) of third nerve paralysis, 24 cases(9.6%) of fourth nerve paralysis, and 22 cases(8.8%) of multiple cranial nerve involvement. The etiologic incidence of the third, fourth and sixth cranial nerve paralysis revealed that trauma was the most frequent(86 cases); other causes were undetermined(59 cases), vascular(37 cases) and tumor(17 cases), in that order. The most common type of recovery was with the fourth nerve paralysis(41.7%).

Refradive Changes after Trabeculectomy

We analyzed 72 eyes of 62 patients with various types of glaucoma who were able to follow up and had controlled intraocular pressure under 21 mmHg by trabeculectomy only, during the period of January 1, 1986 throungh June 31, 1989. The follow-up period was at least 1 year. The corrected visual acuity was reduced in 20 eyes(27.8%) at 3 months postoperatively, and 22 eyes(30.5%) at 1 year postoperatively. The refractive changes were increased myopia or decreased hyperopia in 40 eyes(55.6%) at 3 months postoperatively, and 42 eyes(58.3%) at 1 year postoperatively. There was no statistical significance in refractive change attributable to trabeculectomy procedures, but a tendency to change in the direction of increasing myopia or decreasing hyperopia was observed.

New Technique of Implantation of Posterior Chamber Intraocular Lens in the Absence of Capsular Support: 4 Step Test for Sulcus Fixation

In the aphakic eye of no posterior capsular support, the posterior chamber intracoular lens implantation with suture fixation of the haptics to the sclera at the ciliary sulcus have been popular method. But there are difficulty to know whether the hclptics are exactly fixated in the ciliary sulcus or not and more surgical techniques are required. We have devised a simple and safe methods -4 step test (Guiding up test, Spring test, Knocking test, Lifting and rotating test) for implantation of posterior chamber intraocular lenses in the absence of capsular support with or without suture fixation. We have used this surgical technique for implantation of posterior chamber intraocular lenses in 41 eyes with no capsular support at Kim's eye clinic from July, 1989 to December, 1990. The patients were devided into 3 group-without scleral fixation group (Group A), with superior one point scleral fixation group (Group B), with two point scleral fixation groups (Group C). The results were as followed: 1. Follow up ranged from 6 months to 15 months. 2. The postoperative visual acuity was maintained or improved in 11 eyes (91.6%) of Group A, 9 eyes (69.2%) of Group B, and 12 eyes (75%) of Group C. 3. The most common complication was cystoid macular edema and the others were decentration, hyphema, retinal detachment, ocular hypertension in that order.