Clinical Results of Corneal Triple Procedure and Risk Factors for Graft Failure

PURPOSE: To evaluate the clinical results of corneal triple procedure, as well as the causes and the risk factors for graft failure. METHODS: Indications, survival period of graft, causes of graft failure, and risk factors for failure in 29 patients (29 eyes) who had undergone penetrating keratoplasty combined with cataract surgery and intraocular lens (IOL) implantation were retrospectively analyzed. RESULTS: The most common primary indication of corneal triple procedure was bacterial keratitis (24%), followed by corneal trauma, herpes simplex keratitis, and graft failure. The average survival period of corneal graft in corneal triple procedure was 29.2+/-23.2 months. The most common cause of graft failure was allograft rejection (56.3%). The risk factors of graft failure by an univariate analysis were preoperative unfavorable diagnosis (bullous keratopathy, corneal ulcer, and trauma), corneal neovasculization, intraoperative additional procedure (anterior vitrectomy, synechiolysis, and anterior chamber irrigation), immune rejection, and postoperative glaucoma, but were unrelated to methods of cataract surgery, graft size, or IOL position. In a multivariate analysis, graft rejection and corneal neovascularization were identified as risk factors for graft failure in patients undergoing triple procedure. CONCLUSIONS: Corneal graft in corneal triple procedure had various success rates according to the many factors. Risk factors for graft failure included graft rejection and corneal neovascularization.

The Surgical Effect of Posterior Fixation Suture in Incomitant Strabismus

PURPOSE: To know the surgical effect and the indication of posterior fixation suture in incomitant strabismus. METHODS: From January 2003 to October 2004, posterior fixation sutures were used in five patients with strabismus after orbital wall fracture and in three patients with high AC/A accommodative esotropia. Using Worth 4-dot tests, we compared the amount of incomitant deviation before and after surgery. RESULTS: The mean decrease in deviation after surgery was 7.8+/-2.6PD(P=0.04) in patients with strabismus after orbital wall fracture, and 11.3+/-4.2PD in those with high AC/A ratio accomodative esotropia. CONCLUSIONS: The posterior fixation suture was effective in reducing the amount of incomitant deviation occurring in cases of strabismus after orbital wall fracture and cases of high AC/A accommodative esotropia.

Long-term Outcomes after Surgery for Congenital Unilateral Cataract

PURPOSE: To evaluate the long-term visual outcome after surgery for congenital unilateral cataract in children. METHODS: We retrospectively analyzed age, associated ocular disease, preoperative and postoperative visual acuity, type of cataract, operation method, and final visual outcome in 34 children, 12 years or younger, that had undergone congenital unilateral cataract surgery with a minimum follow-up period of one year. RESULTS: The mean age was 4.9 years and the mean follow-up duration was 26.5 months. Final visual acuity was less than 0.1 in 41.2%, better than 0.2 in 58.8%, better than 0.5 in 32.4%, and better than 0.8 in 20.6%. In the group whose preoperative visual acuity was less than 0.1, 27.2% of the eyes had a final visual acuity better than 0.5. This outcome is statistically significant compared with the 71.4% in the group whose preoperative visual acuity was better than 0.2 (p=0.02). In comparing the portion of patients whose final visual acuity was better than 0.5, only 8.3% were in the age group younger than 2 years at surgery; this is significantly lower than the 40.0% of patients in the age group between 3 to 6 years and the 50.0% of patients older than 7 years (p=0.03) whose final visual acuity was better than 0.5. CONCLUSIONS: Because long-term outcome of surgery for congenital unilateral cataract is not always satisfactory, it is necessary to determine the proper surgical time according to preoperative visual disturbance or severity of cataract, and to also do optical correction and aggressive treatment for amblyopia postoperatively.

Factors of Surgical Success with Unilateral Recession and Resection in Intermittent Exotropia

PURPOSE: To investigate the factors associated with surgical success in cases of unilateral medial rectus resection and lateral rectus recession in the intermittent exotropia. METHODS: Ninety-eight patients with basic-type intermittent exotropia were included in this study. They underwent unilateral recession of the lateral rectus and resection of the medial rectus muscle and were followed postoperatively for at least one year. Surgical results were analyzed to assess the association with preoperative factors, including the angle of deviation, difference of deviation between near and far, stereoacuity at far using B-VAT(R), and Worth 4 dot test (W4DT) at near, and postoperative factors, including the position at near and far at one week, stereoacuity at far using B-VAT(R) at one year, and W4DT at near and far. Surgical success was defined as esotropia within 5 prism diopters (PD) at near and far or within 10PD at near and far at one year postoperatively. RESULTS: Patients with a preoperative difference of deviation between near and far within 5PD had a better surgical outcome than patients with 6~10PD (p=0.03). There was a statistically significant relationship between position at one week postoperatively (especially esotropia or orthotropia at near and far) and success ratio (p0.05). CONCLUSIONS: The difference of preoperative deviation between near and far within 5PD and within 5PD esotropia and orthotropia at near and far at one week postoperatively were significantly associated with a good surgical outcome and could be good prognostic indicators.

The Comparison of Clinical Outcomes between the Triple Procedure and Sequential Procedure in Patients with Corneal Opacity and Cataract

PURPOSE: To compare the differences of clinical results between the triple procedure and the sequential procedure in penetrating keratoplasty and cataract patients. METHODS: Forty-six patients who had undergone a penetrating keratoplasty and cataract extraction simultaneously or sequentially between January 1998 and January 2004 were investigated retrospectively. The uncorrected visual acuity, best corrected visual acuity, spherical equivalent refractive error, average absolute refractive error, corneal endothelial cell counts, average survival period and survival rate were compared between the two groups. RESULTS Seven of 25 eyes (28%) in the sequential procedure group and 3 of 23 eyes (13%) in the triple procedure group had 0.2 or better uncorrected visual acuity (p=0.04). The average absolute refractive error was 3.61+/-2.00 D in the triple procedure group and 2.35+/-1.83 D in the sequential group (p=0.03). There were no statistically significant differences between the two groups in best corrected visual acuity, spherical equivalent refractive error, endothelial cell count, average survival period, or survival rate at final follow-up. CONCLUSIONS: The sequential procedure provides better uncorrected visual acuity and less refractive error. No significant difference was observed in average survival period or survival rate between the triple procedure group and sequential group.

The Comparison of Clinical Outcomes between the Triple Procedure and Sequential Procedure in Patients with Corneal Opacity and Cataract

PURPOSE: To compare the differences of clinical results between the triple procedure and the sequential procedure in penetrating keratoplasty and cataract patients. METHODS: Forty-six patients who had undergone a penetrating keratoplasty and cataract extraction simultaneously or sequentially between January 1998 and January 2004 were investigated retrospectively. The uncorrected visual acuity, best corrected visual acuity, spherical equivalent refractive error, average absolute refractive error, corneal endothelial cell counts, average survival period and survival rate were compared between the two groups. RESULTS Seven of 25 eyes (28%) in the sequential procedure group and 3 of 23 eyes (13%) in the triple procedure group had 0.2 or better uncorrected visual acuity (p=0.04). The average absolute refractive error was 3.61+/-2.00 D in the triple procedure group and 2.35+/-1.83 D in the sequential group (p=0.03). There were no statistically significant differences between the two groups in best corrected visual acuity, spherical equivalent refractive error, endothelial cell count, average survival period, or survival rate at final follow-up. CONCLUSIONS: The sequential procedure provides better uncorrected visual acuity and less refractive error. No significant difference was observed in average survival period or survival rate between the triple procedure group and sequential group.

The Effect of Unilateral Surgery in Dissociated Vertical Deviation

PURPOSE: To investigate changes in the unoperated eye of patients who underwent unilateral surgery for asymmetrical dissociated vertical deviation. METHODS: We performed superior rectus recession and inferior oblique anterior transposition in the case of asymmetrical dissociated vertical deviation, and lateral rectus recession in the case of dissociated horizontal deviation. We excluded patients having a history of previous operation on the vertical rectus muscles, oblique muscle in the unoperated eye, nystagmus, neurologic problems, and imprecise measurement of deviation angle. Changes in the unoperated eyes of 11 patients who underwent unilateral surgery to correct asymmetrical dissociated vertical deviation in the other eye, from May 2003 to April 2004 were analyzed retrospectively at 1 year postoperative. RESULTS: Not all cases of preoperative latent dissociated vertical deviation manifested such deviation in the unoperated eye postoperatively. CONCLUSIONS: Unilateral surgery is an effective treatment in patients with asymmetrical dissociated vertical deviation and does not affect the unoperated eye.