Comparison of materials used in frontalis suspension.

OBJECTIVE: To compare various materials used in frontalis suspension surgery for incidence of infection and/or granuloma formation and incidence of recurrent ptosis. DESIGN AND METHODS: A retrospective medical record analysis was performed for 102 frontalis suspension operations performed on 43 patients between January 1, 1991, and December 31, 1996, at Indiana University Medical Center, Indianapolis. Materials used for surgery were compared for incidence of infection and/or granuloma formation and incidence of recurrent ptosis. Materials included autogenous fascia lata, banked fascia lata, monofilament nylon, braided polyester, expanded polytetrafluoroethylene, and polypropylene. RESULTS: Infection and/or granuloma formation occurred in 10.8% of all frontalis suspensions and in less than 10.0% for each material used except expanded polytetrafluoroethylene. Five (45.5%) of the 11 frontalis suspensions using expanded polytetrafluoroethylene required removal of the material because of suspected infection. Ptosis recurred in 32 cases (31.4%). Low incidence of recurrence was found with autogenous fascia lata and expanded polytetrafluoroethylene. CONCLUSIONS: Of the materials compared in this study, autogenous fascia lata may be the material of choice for frontalis suspension surgery in congenital ptosis. Other materials are useful for temporary eyelid elevation. All materials carry the risk of potential infection and/or granuloma formation.

Ocular myasthenia and nitrofurantoin.

PURPOSE: To report a case of ocular myasthenia associated with administration of nitrofurantoin. METHODS: Case report and review of the literature. RESULTS: While taking nitrofurantoin after urinary tract surgery, a 10-year-old female developed diplopia and ptosis. Sleep test confirmed ocular myasthenia. Signs and symptoms resolved after discontinuation of the drug. CONCLUSION: Ocular myasthenia may be associated with nitrofurantoin administration.

The relationship between nystagmus and surgical outcome in congenital esotropia.

PURPOSE: Congenital esotropia is often associated with congenital nystagmus. This study examines the relationship between the presence of nystagmus and surgical outcome in the treatment of patients with congenital esotropia. METHODS: In this institutional retrospective study, we reviewed the charts of 200 consecutive patients who underwent surgical correction for congenital esotropia between 1991 and 1995. Preoperative clinical characteristics and subsequent need for additional strabismus surgery for a residual or consecutive deviation were noted. Minimum follow-up was 6 months after the original operation. RESULTS: Of the 84 patients who met the inclusion criteria, 15 patients (18%) had latent or manifest latent nystagmus, and 69 patients (82%) had no nystagmus. Eight of the 15 patients with nystagmus had or required reoperation according to our criteria (53%). Nineteen of the 69 patients (28%) without nystagmus had or required reoperation (P =.155). CONCLUSIONS: Nystagmus, when associated with congenital esotropia, may increase the risk of requiring additional strabismus surgery for residual or consecutive deviations. Appropriate and complete preoperative counseling of patients with congenital esotropia who also have nystagmus should include this increased risk.

Pseudomonas-induced bilateral endophthalmitis with corneal perforation in a neonate.

Neonatal endophthalmitis is a rare entity that may be exogenous or endogenous. Pseudomonas aeruginosa is a ubiquitous gram-negative rod that may appear as a nosocomial source of infection in the neonatal intensive care unit. A case of bilateral Pseudomonas-induced endophthalmitis is presented, and a discussion of the case and of the relevant literature follows.