Torsional diplopia after transantral orbital decompression and extraocular muscle surgery associated with Graves' orbitopathy.

Graves' orbitopathy can be associated with horizontal, vertical, and torsional diplopia. Of 428 patients treated with transantral orbital decompression, 21 had incycloduction (mean, 12.8 degrees; range, 5 to 20 degrees) and five had excycloduction (mean, 12 degrees; range, 5 to 20 degrees). All 26 patients had had recessions of the medial or inferior rectus muscle (or both) before onset of torsional diplopia. Mean recession was 5.5 mm (range, 4 to 10 mm) and 5.3 mm (range, 2 to 10 mm) of medial rectus muscle and inferior rectus muscle, respectively. An A pattern was often associated with the condition. Superior oblique tenectomy and inferior oblique myectomy were performed most frequently for incycloduction and excycloduction, respectively. Superior oblique tenectomy induced a mean incycloduction decrease of 7.1 degrees (range, 0 to 12 degrees). Exotropia in downgaze was decreased, and a small ipsilateral hyperdeviation was induced. Bilateral inferior oblique myectomy in one patient decreased excycloduction 10 degrees without inducing new deviation. At follow-up (mean, 63.7 months) after last strabismus operation, 15 patients with incycloduction and two with excycloduction had no diplopia.

Haptic externalization in a backwardly placed anterior chamber intraocular lens.

A patient who had been asymptomatic following extracapsular cataract extraction with posterior capsule rupture and anterior chamber lens implantation presented 18 months postoperatively with iritis and erosion of the superior haptic through the site of the cataract wound. At the time of explantation, it was seen that the anterior chamber lens had been inserted in a backward manner with the anterior face of the lens placed posteriorly. The resultant lens vaulting placed the superior haptic in the same plane as the cataract wound. Whether the superior haptic had initially been incorporated in the surgical wound or had eroded through the eye wall from the anterior chamber, the backward placement of the anterior chamber lens likely played a role in the development of haptic externalization.

A comparison of two preservation media (CSM and K-Sol) by scanning electron microscopy of preserved corneal endothelium.

We compared by scanning electron microscopy the structural preservation of the endothelium of three groups of human corneas after 14 days of refrigerated storage in media, with one eye in K-Sol and the fellow eye in CSM. Each group used a different production lot of CSM and K-Sol. Group 1 comprised ten corneal pairs, and groups 2 and 3 each comprised six corneal pairs. In group 1, K-Sol provided better preservation for each of the ten corneal pairs, but CSM was equal or possibly superior to K-Sol in groups 2 and 3. Variation between different lots from the same manufacturer probably explains the results, which emphasizes the need for consistency in the composition of these preservative media. Large areas of endothelial cell disruption were found in the periphery of the majority of the corneas. Seven of the 44 corneas had no viable endothelial cells. As storage times increase, methods are needed to detect corneas that are not well preserved. We found no consistent differences in the efficacy of corneal preservation between CSM and K-Sol.

Replication of fungi in K-Sol corneal preservation medium at 4 degrees C.

We examined the growth of six fungi during 18 days at 4 degrees C in a corneal preservation medium containing 2.5% chondroitin sulfate (K-Sol). The number of viable organisms decreased with time for all six fungi, the average decrease being 65%. The risk of transplanting fungal organisms with a donor cornea stored for up to 18 days at 4 degrees C in preservation media containing chondroitin sulfate is no greater than that with the same cornea stored for only one day.