PURPOSE: To compare the effect of medial rectus recession in consecutive esotropes who had previous monocular medial rectus resection and lateral rectus recession and in non- accommodative esotropes (NAET) with small angle of deviation who had no prior operation. METHODS: We studied the results of unilateral medial rectus recession at postoperative 2 and 6 months in 7 consecutive esotropes and 19 NAET with deviation angle around 20 PD, and analyzed the corrected amount for 1 mm medial rectus recession. We regarded deviated angle of+/-8 PD at orthophoria as successful operation. RESULTS: The abosolute value of remained deviation in consecutive esotropes and NAET were 4.86+/-5.67 PD and 9.05+/-3.95 PD at postoperative 2 months, and 5.42+/-7.89 PD and 8.26+/-4.45 PD at postoperative 6 months, respectively. There were significant differences between at postoperative 2 and 6 months (p<0.05). The success rates in consecutive esotropes and NAET at postoperative 2 months were 86% and 42%, and 71% and 47%, respectively at postoperative 6 months, which were no significant differences (p>0.05). The average amount of corrected deviation for 1 mm recession at postoperative 6 months was 5.84 PD in consecutive esotropes and 2.97 PD in NAET, which were significant differences (p<0.05). CONCLUSION: Unilateral medial rectus recession in consecutive esotropes may be a useful and first choice of operation procedure when considering second operation. The amount of correction for 1 mm medial rectus recession is larger in consecutive esotropes than in NAET, possibly due to previous resection of medial rectus or release of fat adhesion. Therefore the amount of medial rectus recession in consecutive esotropia should be determined after considering the degree of abduction and operative findings.
Esotropia*

Traction of the extraocular muscles during strabismus surgery could cause nausea and vomiting in postoperative period. Although the extent of these symptoms would vary in wide range, sometimes they are so severe that patients may feel very uncomfortable and have difficulties with adjusting back to their routine life in immediate postoperative period. Authors have investigated whether the 5-hydroxytryptamin-3 [5HT3] receptor antagonist, which is now used as an effective antiememtic agent after general anesthesia and anticancer chemotherapy, can control the nausea and vomiting after strabismus surgery or not. As the occurrence of the oculocardiac reflex during strabismus surgery is closely related with postoperative emesis, we also examined if 5HT3 receptor antagonist can suppress the oculocardiac reflex as well. We performed strabismus surgery in 80 patients under topical anesthesia. In experimental group[N=40], 3 milligramof Granistron in 50 milliliter of normal saline was administered intravenously and in control group[N=40], the same amount of normal saline was administered one hour before the surgery. To evaluate the degree of nausea and vomiting, authors used the Rhodes 'Nausea and Vomiting Estimation Index[NVEI]and monitored heart rate for oculo-car-diac reflex. The NVEI in experimental group was 12.10 +/-5.60 compared with 16.85 +/-8.88 in control[P=0.005]. But there was no difference in frequency of oculocardiac reflex and the degree of heart rate decrement between the two groups [P=0.152, P=0.345]. In conclusion, Granisetron, 5HT3 receptor antagonist, is still effective in controlling the nausea and vomiting after strabismus surgery, but it has no suppressive effect on the oculocardiac reflex.
Anesthesia* ; Anesthesia, General ; Drug Therapy ; Granisetron ; Heart Rate ; Humans ; Muscles ; Nausea* ; Postoperative Nausea and Vomiting ; Postoperative Period ; Receptors, Serotonin, 5-HT3* ; Reflex ; Reflex, Oculocardiac ; Strabismus* ; Traction ; Vomiting*

Traction of the extraocular muscles during strabismus surgery could cause nausea and vomiting in postoperative period. Although the extent of these symptoms would vary in wide range, sometimes they are so severe that patients may feel very uncomfortable and have difficulties with adjusting back to their routine life in immediate postoperative period. Authors have investigated whether the 5-hydroxytryptamin-3 [5HT3] receptor antagonist, which is now used as an effective antiememtic agent after general anesthesia and anticancer chemotherapy, can control the nausea and vomiting after strabismus surgery or not. As the occurrence of the oculocardiac reflex during strabismus surgery is closely related with postoperative emesis, we also examined if 5HT3 receptor antagonist can suppress the oculocardiac reflex as well. We performed strabismus surgery in 80 patients under topical anesthesia. In experimental group[N=40], 3 milligramof Granistron in 50 milliliter of normal saline was administered intravenously and in control group[N=40], the same amount of normal saline was administered one hour before the surgery. To evaluate the degree of nausea and vomiting, authors used the Rhodes 'Nausea and Vomiting Estimation Index[NVEI]and monitored heart rate for oculo-car-diac reflex. The NVEI in experimental group was 12.10 +/-5.60 compared with 16.85 +/-8.88 in control[P=0.005]. But there was no difference in frequency of oculocardiac reflex and the degree of heart rate decrement between the two groups [P=0.152, P=0.345]. In conclusion, Granisetron, 5HT3 receptor antagonist, is still effective in controlling the nausea and vomiting after strabismus surgery, but it has no suppressive effect on the oculocardiac reflex.
Anesthesia* ; Anesthesia, General ; Drug Therapy ; Granisetron ; Heart Rate ; Humans ; Muscles ; Nausea* ; Postoperative Nausea and Vomiting ; Postoperative Period ; Receptors, Serotonin, 5-HT3* ; Reflex ; Reflex, Oculocardiac ; Strabismus* ; Traction ; Vomiting*

PURPOSE: We introduce a new surgical procedure for punctal stenosis, which is to insert a soft and thin cut-down tube, commonly used in general surgery. METHODS: After two snip operation, we inserted cut-down tube into canaliculus through incised punctum. We cut the tube for not touching to the cornea and buried in incision site. At postoperative 1 day, we asked patients their uncomfortness and examined ocular state with slit lamp. And then we removed the tube 4 days later. At postoperative 2 month, we evaluated whether epiphora improved or not and estimated the size of dialted punctum with caliper. Dye disappearance test and lacrimal irrigation test were also performed. RESULTS: Of 11 patients, 8 patients had no epiphora. Average diameter of dilated punctum was 1.77 +/- 0.20mm. In all patients, we found dilated punctum more than 1mm and confirmed patency by lacrimal irrigation test. 8 patients did not feel uncomfortness, and 3 patients felt a little uncomfortness. But no one felt severe discomfort. Although we found corneal erosion and conjunctival injection in 2 patients, they recovered in a few days. CONCLUSIONS: By this procedure, we reduced patient's hospital visit and pain resulting from postoperative care. And we observed well dilated punctum after the procedure. Therefore, punctoplasty using cut down tube is useful procedure for punctal stenosis, especially for recurrent stenosis after snip operation.
Constriction, Pathologic ; Cornea ; Humans ; Lacrimal Apparatus Diseases ; Postoperative Care

Generally, the postoperative failure of glaucoma filtrationsurgery(GFS) is caused by scarring of filtering site. Mitomycin C(MMC) has been commonly used for preventing the scarring of filtering site. Though the antifibroblastic effect of this drug is approved clinically, its cytotoxic side effect cannot be overlooked,. alpha-tocopherol is known to inhibit proliferation of fibroblast without cytotoxic complications. In this study, we used alpha-tocopherol in GFS of rabbits and investigated the maintenance of bleb formation, complications and inhibition of fibroblast proliferation compared with MMC. Thirty six rabbits were divided into 6 groups Negative control groups were the balanced salt solution soaked group and the 19% ethanol soaked group and positive control group was soaked with 0.2mg/ml MMC during GFS. As experimental groups, group I, II, III were soaked with 100micrometer, 1mM and 10mM alpha-tocopherol. The results were as follows: For the maintenance of bleb formation, at postoperative 2 weeks, all extinguished in negative control groups and each experimental groups from I to III showed 16.7%, 33.3%, 50%, with highest rate of 66.7% in MMC soaked group, but at 2 months, group III and MMC soaked group showed 33.3% equally. Various complications were present in MMC soaked group but rare in alpha-tocopherol soaked groups. On histologic examinations, proliferation of fibroblast and infiltration of lymphocyte in group II, III and MMC soaked group except group I were much less than those of negative control groups and the degree of inhibition was proportional to concentration of tocopherol. There was no statistic difference(P>0.05) in area of reticulin fibers between group III and MMC soaked group and antifibroblastic effects were also similar between these two groups. These result suggest when directlyconcentration(1mM<) as much as MMC. Moreover, it is expected to be used more safely during GFS withous serious cytotoxic complications. However, application method, dosageand possible long term complications.
alpha-Tocopherol* ; Blister ; Cicatrix ; Ethanol ; Fibroblasts* ; Filtering Surgery* ; Filtration* ; Glaucoma* ; Lymphocytes ; Mitomycin ; Rabbits* ; Reticulin ; Tocopherols

PURPOSE: To investigate the results of acellular dermal allograft (SureDerm(R), Hans Biomed Co., Korea) as a new covering material in the exposure of hydroxyapatite orbital implant. METHODS: SureDerm graft was performed in 5 patients with exposed hydroxyapatite orbital implant. Under local anesthesia, the anterior surface of the exposed implant was trimmed and the designed SureDerm was sutured at the margin of the sclera with 6-0 Vicryl. Finally, conjunctival suture was done. The patients were followed up regularly until postoperative 10 months. RESULTS: The average diameter of exposed implant was 9.6 X 9.0 mm. The grafted SureDerm had survived in all patients at postoperative 10 months and exposure of implant was treated successfully in all cases. CONCLUSIONS: We consider that acellular dermal allograft will be a good replacing material when preserved sclera is not available. It also features the advantage of avoiding the intricate harvesting procedure and the scarring of the donor site in dermo-fat graft.
Allografts* ; Anesthesia, Local ; Cicatrix ; Durapatite* ; Humans ; Orbit* ; Orbital Implants* ; Polyglactin 910 ; Sclera ; Sutures ; Tissue Donors ; Transplants

Preoperarive measurement of strabismic angle is most important procedure in determining the amount of surgery.But measured angles are not always the same at each examination, which is quite a steress to both the operator and the patient because additional examination has to be done for accurate determination of surgical amount and also because the confidence for planned amount of surgery may be reduced.Therefore we investigated the variance of preoperative measurements and evaluated the necessity of repeated examinations. We compared the variance of measurement and investigated the bias and reliability of repeated examinations, from 104 patients who were examined initially by a resident at first visit and examined repeatedly at least 3 times before operation by a specialist.Also, the degree of variance in measurement and its relation with postoperative result were evaluated. The differences in measurement between resident and specialist was average 2.37 prism diopters, which was not significant on reliability analysis.Also, there were no significant differneces among 3 measurements by specialist. The degree of variance decreased with increasing age and the larger the degree of variance in measurement, the larger the deviation which may be remained postoperatively. The results suggest that the angle of deviation measured by resident is reliable and repeated measurements do not differ significantly[p>0.05], and also confirms that the variation of these measurements is an important factor which can influence postoperative results.
Bias (Epidemiology) ; Exotropia* ; Humans ; Specialization

Most people think that ophthalmology only treat diseases of the eyeball, but there are also many diseases of the accessory organs around the eyeball. Oculoplasty is a field of ophthalmology that deals with diseases of the eyelids, lacrimal system, and orbit. These accessory organs play important roles in protecting the eyes and supporting their function. Sometimes, diseases of these organs cause cosmetic problems, as well as functional problems. In the past, this field was considered rather indifferently and was not well recognized, so the treatment of these diseases was not specialized. However, concomitantly with recent improvements in quality of life and the increased desire of patients for these diseases to be treated, the importance of this field is increasing and many oculoplastic specialists are being trained. In the oculoplastic field, wide range of diseases are treated. In this report, the author provides a brief overview of the most important and common oculoplastic diseases.
Eyelid Diseases ; Eyelids ; Humans ; Lacrimal Apparatus Diseases ; Ophthalmology ; Orbit ; Orbital Diseases ; Quality of Life ; Specialization

PURPOSE: To investigate the surgical outcome of silicone tube intubation after simple probing performed in obstruction of distal part of canaliculus or common canaliculus. METHODS: Silicone tube intubation was done in 24 patients with obstruction of distal part of canaliculus or common canaliculus, whose obstruction was readily opened by simple probing under mild pushing pressure and who had successful lacrimal irrigation after probing. Silicone tube was removed at about 6 months after operation and the epiphora improvement, dye disappearance test, and lacrimal irrigation test were evaluated at 2 month after the intubation and 2 months after the tube removal. RESULTS: The average of probing to perforate the obstructed canaliculus were 2.1. At 1 month after the intubation, epiphora was improved in 19 patients (79.2%), and 18 patients (75.0%) showed a grade 2+ or lower in dye disappearance test, and lacrimal irrigation was successful in 21 patients (87.5%). 2 months after the tube removal, epiphora was improved in 18 patients (75.0%), and 18 patients (75.0%) showed a grade 2+ or lower in dye disappearance test, and lacrimal irrigation was successful in 20 patients (83.3%). CONCLUSIONS: When the obstruction of distal part of canaliculus or common canaliculus is thin membranous nature, good surgical outcome can be expected by silicone tube intubation after simple probing using mild pushing pressure without other special procedure.
Humans ; Intubation* ; Lacrimal Apparatus Diseases ; Silicones*

Endogenous endophthalmitis is rare, but when it occurs, there is high probability of visual loss in spite of early diagnosis and treatment. But in many patients, it is difficult to find exact primary site, and even if there is a presumed site, it is difficult to disclose causative organisms. As a result, proper antibiotic treatmaent may not be carried out in some cases. In a 55 year old man who suffered from liver abscess, we experienced a case of endogenous endophthalmitis accompanied by severe orbital cellulitis caused by klebsiella pneumoniae from liver abscess, and ocular symptom improved after identification of pathogen and antibiotic administration. However visual loss could not be prevented. So, we first report this case with a review of available literatures and remind seriousness of this disease at the same time.
Early Diagnosis ; Endophthalmitis* ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess* ; Liver* ; Middle Aged ; Orbit* ; Orbital Cellulitis*