Slanted medial rectus recesection for treatment of exotropia with convergence insufficiency strabismus: a report of results in 15 cases.

PURPOSE: To evaluate the surgical and functional results of slanted medial rectus resection for treatment intermittent exotropia of the convergence insufficiency type. METHODS: Fifteen patients with near vision asthenopia and intermittent exotropia of the convergence insufficiency type were included in this prospective study. The upper edge of the MR was resected more than the lower edge. Slanted bilateral or unilateral medial rectus resection was performed. The mean length of follow-up was 14.9 months. RESULTS: Slanted medial rectus resection(s) caused a significant postoperative reduction in the mean distance exodeviation from 11.40 to 4.53 PD, as well as a change in the mean near exodeviation from 23.93 to 10.73 PD. Although mean near-distance difference reduced from 12.53 to 6.2 PD. In final examination, 11 patients showed surgical success rate and recurrent exotropia occurred in 4 cases. On the other hand, 13 cases had experienced significant relief from their symptoms. CONCLUSION: Slanted medial rectus resection is useful in decreasing the symptoms of intermittent exotropia of the convergence insufficiency type. However, it can result in undercorrection in larger deviations.

Large angle esotropia with high myopia and a lost medial rectus muscle: a case report.

A 67 year old woman presented with her left eye fixed in adduction and infraduction. She had previous complicated strabismus surgery 18 years ago with a report of intraoperative loss of left medial rectus (MR) muscle (not retrieved at the time of surgery). An Orbital MRI of the left eye showed reattachment of the MR muscle to the globe and an axially enlarged globe associated with inferior displacement of the lateral rectus and nasal displacement of the superior rectus muscles. In ultrasonography the axial lengths were 24.1 mm in the right and 29.9 mm in the left eye. She underwent staged surgery: The first stage was a recession of the left MR muscle and union procedure on the SR and LR muscles followed by a second adjustable suture procedure under topical anesthesia, of right MR recession, right LR resection and left IR recession. After 12 months her eyes were still binocularly aligned. Unilateral high myopia must be considered in progressive esotropia. Imaging and ultrasonography can demonstrate anatomical abnormality and muscle paths to confirm the definite diagnosis. Union procedure described by Yokoyama is an effective procedure in correcting this strabismus associated with high myopia.

Bupivacaine injection myotoxicity on extraocular muslces. A strabismus alternative treatment: extended histological changes induced in a rabbit model.

PURPOSE: To evaluate longer term histological changes of extraocular muscles induced by bupivacaine toxicity. METHODS: The superior rectus and inferior rectus of white rabbits were injected with 0.4 mg of agent in 0.3 ml of bupivacaine., Then, histological changes of these rectus muscles were examined at 1,2,4 and 8 weeks after injection. RESULTS: Bupivacaine injection induced myotoxic changes in both orbital and global layers. Regenerating myofibers were found at 1 week after injection. These changes were reduced by 4 weeks post injection. At 4 weeks increasing muscle fiber size in both orbital and global layer were seen. There was no scar formation after 8 weeks post injection. CONCLUSIONS: Extraocular muscle bupivacaine injection can cause acute myonecrosis followed with regeneration. After 8 weeks the muscles recovered with arranged myofibers almost at normal level. However we found increased myofiber diameter at 4 weeks after injection which was remained stable until 8 weeks post injection, Further investigation about functional change in these muscles is needed to facilitate application of this methodology.

Successful extraocular muscle re-resection for a strabismus surgery complication: a "snapped" [severed, inadvertently] and retrieved inferior rectus muscle: a case report.

A 26- year-old woman who had a left head tilt since childhood was undergoing left inferior rectus resection to correct her left inferior rectus paresis. During the surgery, when the inferior rectus was isolated and engaged with an eye muscle hook, the muscle tore (snapped) completely into two pieces, 8 mm posterior to insertion. Fortunately, we were able to find the proximal portion of the muscle and, after a 3 mm resection, of the distal yet attached 8 mm portion, the proximal and distal portions were sutured together with a non-absorbable suture. After nine months followup there was significant diplopia, and the preoperative left head tilt and left hypertropia remained, so a left inferior rectus re-resection was done. At the end of 18 months followup after the second procedure there was no binocular deviation (strabismus) in primary position nor in any other gaze positions, but there was a mild ocular motility infraduction deficit present on left and down gaze.

Comparison of efficacy of azithromycin vs. doxycycline in the treatment of rosacea: a randomized open clinical trial.

BACKGROUND: Rosacea is a common inflammatory disorder of the skin. Systemic antibiotics currently used in the treatment of rosacea are sometimes associated with uncomfortable side effects. Therefore, a need for an effective agent with few side effects and good patient compliance exists. Azithromycin, a macrolide antibiotic with prolonged mode of action, has recently been found to be an effective alternative in the treatment of inflammatory acne. METHODS: For evaluation of the efficacy of azithromycin in the treatment of rosacea, we planned a randomized, open, clinical trial study to compare the efficacy of azithromycin with doxycycline in the treatment of this disease. Sixty-seven patients were randomized to receive either azithromycin 500 mg thrice weekly (on Monday, Wednesday, and Saturday) in the first, 250 mg thrice weekly (on Monday, Wednesday, and Saturday) in the second, and 250 mg twice weekly (on Tuesday, and Saturday) in the third month. The other group was given doxycycline 100 mg/day for the three months. Clinical assessment was made at baseline, at the end of first, second, third, and 2 months after treatment. Side affects were recorded. The limitation of this study is that there was no blindness. RESULTS: Statistically significant improvement was obtained with both drugs. Neither drug was shown to be more effective than the other. In the azithromycin group four patients had diarrhea, while epigastric burning was seen in two patients using doxycycline. CONCLUSION: This study indicates that azithromycin is at least as effective as doxycycline in the treatment of rosacea.