Effects of vertical offsets of the horizontal rectus muscles in V-pattern exotropia without oblique dysfunction.

PURPOSE: To investigate the effects of vertical offsets of the horizontal rectus muscle in V-pattern exotropia without oblique dysfunction. METHODS: A computerized patient database was searched for patients treated with full tendon offsets for V-pattern strabismus from 2002 to 2007. Patients with clinically significant inferior oblique overaction were excluded. Surgery included upward transposition of lateral rectus muscles and/or downward transposition of medial rectus muscles. Medical records were retrospectively analyzed for alignment in the primary position, 30 degrees upgaze, and 30 degrees downgaze before and 3 months after surgery. The main outcome measure was the change in V pattern after surgery. RESULTS: The search identified 11 patients who met inclusion criteria. Of these, 6 underwent bilateral lateral rectus recessions, 1 had 3-muscle surgery, and 4 had monocular recession-resection surgery. The preoperative V-pattern (horizontal) deviation between upgaze and downgaze was 22.2(Delta)+/-5.0(Delta). Postoperative deviation at 3 months was 3.5(Delta)+/-3.9(Delta), a decrease of 18.9(Delta)+/-7.5(Delta). Postoperatively, no patient had an A-pattern deviation or subjective torsional disturbance. The amount of V-pattern correction was closely correlated with the size of the preoperative V pattern (r=0.84). CONCLUSIONS: In patients with V-pattern exotropia without inferior oblique dysfunction, vertical offsets of the horizontal rectus muscles effectively corrected the pattern deviation. The amount of correction was closely correlated with the size of the preoperative V pattern.

Modified method for assessment of the binocular fusional field in patients with suppression.

PURPOSE: To evaluate the usefulness of a new system using a modified Goldmann perimeter and Bagolini striated glasses for quantitative assessment of the binocular fusional field (BFF) in patients with suppression. METHODS: The BFF was assessed quantitatively in ten normal patients aged 10 to 15 years by using a modified Goldmann perimeter equipped with a xenon light source. Subjective perception was elicited with the use of a crossed or single oblique streak through Bagolini striated glasses. The BFF in 15 strabismic patients with suppression were analyzed at their initial visit and at their last visit after therapy. RESULTS: In normal patients, extent points of the BFF on every 15 degrees meridian ranged from 48 degrees to 56 degrees . The normal BFF drawn from these average points was approximately equal to the previously published normal format of binocular single vision for strabismic patients with diplopia. Additionally, this scoring system for BFF provided quantitatively objective information during the course of their extraocular disorder in 15 strabismic patients with suppression. CONCLUSION: This new method of assessing BFF in patients with suppression can be helpful for evaluation of quantitative effects in the course of treatment for an extraocular disorder and compensatory abnormal head position.

[Anterior segment fluorescein angiography for evaluating the effect of vitrectomy for neovascular glaucoma].

PURPOSE: Using anterior segment fluorescein angiography(AFA), we evaluated the relationship between the effect of vitrectomy combined with endophotocoagulation for neovascular glaucoma and the postoperative angiographic changes. SUBJECTS AND METHODS: Seven eyes of 7 patients (six eyes of 6 patients had proliferative diabetic retinopathy and 1 eye of 1 patient had central retinal vein occlusion) with neovascular glaucoma underwent both vitrectomy combined with endophotocoagulation and AFA before and after surgery. RESULTS: Of the 7 cases, the three eyes(42.9%), ther received one vitreous surgery alone had a reduction in intraocular pressure (IOP). The other 4 with uncontrollable IOP underwent trabeculectomy additionally, and three of them achieved good control of IOP. AFA showed less dye leakage in the iris after surgery in all cases. Three of 4 eyes with less dye leakage in the chamber angle showed good IOP control. Two of 3 eyes without the change in dye leakage were treated additionally by trabeculectomy. CONCLUSION: AFA is a sensitive technique in the assessment of neovascularization in the anterior segment, so that it is useful in evaluating the effect of vitrectomy combined with endophotocoagulation for neovascular glaucoma.

Surgical management of retinal detachment associated with myopic macular hole: anatomic and functional status of the macula.

PURPOSE: To evaluate the postoperative status of the macula after vitreous surgery with internal limiting membrane removal for macular hole related retinal detachment in patients with severe myopia. DESIGN: Interventional case series. METHODS: We prospectively examined 10 eyes with retinal detachment associated with a myopic macular hole from 10 consecutive patients, and performed pars plana vitrectomy with internal limiting membrane peeling. Macular buckling was performed in one eye during the initial treatment and in three eyes during subsequent operations. The main outcome measures were the anatomic reattachment rate and the postoperative status of the macular hole. We examined the macular area pre- and postoperatively with slit-lamp biomicroscopy and with a scanning laser ophthalmoscope. Cross-sectional imaging of the macular area was conducted with optical coherence tomography. RESULTS: Successful retinal reattachment was achieved in seven eyes (70%) after the initial surgery and in three eyes (30%) after additional procedures. Visual acuity remained unchanged in two eyes (20%), and improved by two or more logarithmic units of minimum angle of resolution (logMAR) measurement in eight eyes (80%). The macular hole was anatomically closed in only one eye (10%). Postoperative enlargement of the macular hole was observed in seven eyes. CONCLUSIONS: In highly myopic eyes with macular hole related retinal detachment, closure of the macular hole is difficult to attain despite the complete relief of tangential traction by internal limiting membrane peeling. Results indicate the presence of a possible imbalance between the retina and the choroid-sclera complex associated with axial elongation and posterior staphyloma in highly myopic eyes.

[A case of choroidal rupture due to blunt ocular trauma healed with proliferative tissue protruding into the vitreous cavity].

BACKGROUND: Indirect choroidal rupture due to blunt ocular trauma involves rupture of the choriocapillaris or the full thickness of the choroid and Bruch's membrane. The overlying retinal pigment epithelium and the sensory retina are usually intact or atrophic, but rarely ruptured. We report a case of choroidal rupture healed with proliferative tissue protruding through the sensory retina into the vitreous cavity. CASE: A 22-year-old man was punched in the left eye. Hypotony maculopathy and choroidal rupture passing through the macula were noted. RESULTS: The intraocular pressure was normalized after suturing of the dialyzed ciliary body to the sclera and hypotony maculopathy was cured. Proliferative tissue formation protruding through the sensory retina into the vitreous cavity was observed 1 month after the injury. Corrected visual acuity was improved from 0.09 to 0.6. Optical coherence tomography showed that the site of the proliferative tissue was located immediately temporal to the fovea and that the fovea kept its normal form. CONCLUSION: Optical coherence tomography was useful in monitoring the morphological change in the macula and predicting visual acuity in a case of blunt ocular trauma involving the macular area.