We performed clinical evaluations on 26 patients who were prescribed glasses with full correction and Fresnel prism for correction of abnormal head posture and/or diplopia due to incomitiant paralytic strabismus. There were 12 cases(46.2%) of superior oblique muscle palsy and 8 cases(30.8%) of lateral rectus palsy in order. Trauma was the most common cause, but non-traumatic cases were mostly caused by vascular disease of diabetes mellitus and/or hypertension. Abnormal head posture with diplopia and/or dissociated diplopia may be one of the causes of less satisfaction level than interval of prescription of Fresnel prism. Decreased visual acutiy happened when prescribed above ten prism prescription on one eye, and patients accepted with more ease when prescription wasdivided on both eyes, in spite of low prism power. We concluded that it is necessary to explain dimness due to decreased visual acuity when above ten prism power prescription is given on one eye even though prism was more effective method for diplopia gteatment.
Abducens Nerve Diseases ; Diabetes Mellitus ; Diplopia ; Eyeglasses ; Glass ; Head ; Humans ; Hypertension ; Paralysis ; Posture ; Prescriptions ; Strabismus* ; Vascular Diseases ; Visual Acuity

The human papillomavirus(HPV) has been implicated in the pathogenesis of human conjunctival papilloma, becauses it has clinically viral nature and pathologically koilocytosis, typically found in other papilloma-induced tumors. To evaluate the association of HPV with conjunctival papilloma, 3 recurrent conjunctival papiloma were removed through cryo-excision and examined for the presence of human papillomavirus by polymerase chain reaction. All 3 cases were positive reactions to papillomavirus serotype 6/11, but koilocytosis was present in 2 cases.
Humans* ; Papilloma* ; Polymerase Chain Reaction

Children with mature visual functions can suffer from diplopia when overcorrection after strabismus surgery occurred. If the patients are willing to undergo the adjustment procedure under a topical anesthesia, we feel that it is also possible to perform the strabismus surgery in the same manner. We operated 58 strabismic children (male 37, female 21) aging from 6 to 14 under topical anesthesia using only 0.5% proparacaine (Alcaine). After bow tie suture around end of the surgery, patients were assisted in sitting upright on the operating table, asked to fixate on a 20/40 accomodative target. Subsequently, we adjusted ocular alignment to nearly orthophoria. The overall success rate was 67.2% (39/58) ; horizontal strabismus with fusion potential (74.4%) was more successful than horizontal and/or vertical combined strabismus without fusion potential (52.6%) and one muscle surgery in horizontal strabismus regardless of fusion potential (36.4%). In conclusion, this study revealed that strabismus surgery under topical anesthesia had many advantages including day surgery, decreased complications and decreased the number of surgery.
Aging ; Ambulatory Surgical Procedures ; Anesthesia* ; Child ; Diplopia ; Female ; Humans ; Operating Tables ; Strabismus* ; Sutures

PURPOSE: Exercise-induced bronchospasm (EIB) is widely prevalent in asthmatic patients. Recently, eosinophilic airway inflammation and atopy (defined as skin sensitivity to common aeroallergens) are considered to be a important factors in the pathogenesis of asthma. Thus we studied to find out the effect of atopy and airway eosinophilic inflammation on exercise- induced bronchospasm. METHODS: We followed up the cases of 132 mild asthmatics for 2 years. On their first visit, skin prick tests, with 29 common allergens including dust mites antigen, and sputum induction were performed. And 3 days later, methacholine challenge was done. 24 hours after methacholine challenge, treadmill test was performed and the positive EIB was defined as a 15% reduction or more in FEV1 from baseline after exercise. RESULTS: EIB was observed in 54 (40.9%) of 132 asthmatic subjects. There was no significant difference in atopy between EIB positive and EIB negative asthmatics. Eosinophil and eosinophil cationic protein in induced sputum were significantly higher in EIB positive asthmatics. We also found the significant correlation between bronchial responsiveness (BR) index and maximal % fall in FEV1. CONCLUSION: The severity of bronchospasm evoked by exercise was more closely related to eosinophilic airway inflammation and airway hyperresponsiveness to methacholine than atopy.
Allergens ; Asthma ; Asthma, Exercise-Induced* ; Bronchial Spasm ; Dust ; Eosinophil Cationic Protein ; Eosinophils* ; Exercise Test ; Humans ; Inflammation* ; Methacholine Chloride ; Mites ; Skin ; Sputum

PURPOSE: This study was conducted for the use of nasal continuous positive airway pressure (CPAP), by comparing the early use of non-invasive nasal CPAP with low intermittent mandatory ventilation(low IMV) and endotracheal CPAP in weaning a mechanical ventilator from infants with moderate respiratory distress syndrome(RDS). METHODS: Thirty infants in the study group, with moderate RDS from November 2001 to June 2002, were administered surfactants and treated with the mechanical ventilator, and applied the nasal CPAP in weaning. Thirty infants of the control group, from January 1999 to September 2001, were applied low IMV and endoctracheal CPAP in weaning. RESULTS: There were no significant differences in the characteristics, the severity of clinical symptoms, the initial laboratory findings and settings of the mechanical ventilator. After weaning, the study group showed no significant changes in PaCO2. However, the control group showed a slight CO2 retension after one and 12 hours. Twenty eight infants(93.3%) of the study group and 24 infants(80%) of the control group were successfully extubated. The primary cause of failure was apnea. There were no significant differences in the duration of weaning and the mechanical ventilator treatment between the groups. Complications in weaning were related to the fixation of nasal CPAP and the mechanical problems caused by endotracheal tube. CONCLUSIONS: Aggressive weaning is possible for moderate RDS, in which the nasal CPAP was used without the low IMV and the endotracheal CPAP process. It had no difficulties. In conclusion, the nasal CPAP is an adequate weaning method for moderate RDS.
Apnea ; Continuous Positive Airway Pressure ; Humans ; Infant ; Surface-Active Agents ; Ventilators, Mechanical* ; Weaning*

We studied the utility of hand held autorefractometer on the cycloplegic refraction for poor coorperated children by analyzing the data taken from hand held autorefractometer(Retinomax) and Canon R-10 autorefractometer. Seventy patients(140 eyes) were studied. We divided them into two groups according to the age: Group I included patients less than 4 years, Group II over 4 years. There were no statistic significant differences in the spherical and cylindrical values regardless of age and cooperability in cases of less than 6 diopter but statistic significant difference in cases of high refractive errors (>6 diopter) or cylindrical axis values. In Conclusion, this study revealed that hand held autorefractometer was useful for checking refraction of the poor coorperated children and the spherical and cylindrical values of Retinomax have no differences from the values of R-10 in the cases of less than 6 diopter.
Axis, Cervical Vertebra ; Child* ; Hand* ; Humans ; Refractive Errors

Ectopic macula is a condition in which the macula is displaced markedly from its normal position. It can be unilateral or bilateral, and the macula can be displaced in any direction, though it is displaced temporally in more than 90% cases. The occurrence of small variation of the position of the macula in relation to the pupillary axis of the eye is evidenced by the variability of the angle K. The most common cause of ectopic macula is probably retinopathy of prematurity and other causes are trauma, chorioretinitis, and angioma. The authors experienced six patients who had ectopic macula. They presented apparent exptropia on Hirschberg test, but no fixation movement on cover test. Fundus examination showed temporal displacement of macula and traction vessel. Pseudoexotropia result from positive angle kappa. It is dangerous to measure the deviation amount by only Hirschberg test or Krimsky test for the uncooperated young patients who have history of prematurity especially. We must check the fundus photographs. With regards to cosmetic surery, each case must be handled individually. Evaluation should include age, visual acuity, the status of binocular vision, and the angle of squint.
Axis, Cervical Vertebra ; Chorioretinitis ; Hemangioma ; Humans ; Retinopathy of Prematurity ; Strabismus ; Traction ; Vision, Binocular ; Visual Acuity

Inadvertent perforation of the globe, granuloma and hypersensitivity reaction have been recognized complications of the strabismus surgery. We performed experimental strabismus surgery with No.240 retinal band and histoacryl(group I), histocracyl only(group II), 6-0 vicryl(group III) in rabbit model to determine whether these techniques can replace the classic suture and decrease its complications. We measured maximum adhesion power by force gauge and observed histopathologic findings after sacrificing four rabbits at 1 day, 1 week, 4 week, and 8 weeks, respectively following experimental strabismus surgery. There were chronologically increasing tendency of adhesion power in all groups but no statistically significant differences among three groups. Pathologically inflammatory and foreign body reactions were decreased with time and there were no differences of inflammatory reactions among three groups. At four weeks after the experiment, there was encapsualation lined with loose fibrous tissue around the band in group I.In conclusion, We found that experimental strabismus surgery with tissue adhesives and No.240 retinal band showed good adhesion power and minimal tissue reaction. So, it is possible to do posterior fixation suture with tissue adhesive and No.240 retinal band in classic strabismus surgery.
Foreign Bodies ; Granuloma ; Hypersensitivity ; Rabbits ; Retinaldehyde ; Strabismus ; Sutures* ; Tissue Adhesives*

This study was undertaken to evaluate the relationship between eye positions in the awake state and in the surgical plane of anesthesia induced with anesthetics and muscle relaxants in 167 non-paralytic horizontal strabismus patients. All 27 patients with esotropia demonstrated divergence under general anesthesia when compared with their pre-anesthetized state. In 140 patients with exotropia, 107 patients(76.4%) demonstrated convergence under general anesthesia, 6 patients(4.3%) demonstrated divergence, 27 patients demonstrated no change of the eye position. A statistically significant relationship was found between the preanesthetized position of the eyes(P) and the eye position under general anesthesia(A). The relationship is linear and can be written as the approximate regression fomula: A=0.44P+6.34, R=0.73(p<0.01). When surgical success was defined as an eso- or exodeviation within 10 delta of orthotropia at postoperative 12 weeks, final success rate revealed statistically significant difference between the following two groups of exotropic patients(p<0.05). The patients whose amount of vergence were under 15 delta had a success rate of 96.6%, while those over 16 delta had a success rate of 86.3%. In esotropia, surgical success was not satisfactory in patients whose amount of deviation were over 41 delta. These results suggest the significant relationship between eye positions in the awake state and those under general anesthesia, which could be clinically applied in deciding the surgical amount and predkting the success of strabismus surgery.
Anesthesia ; Anesthesia, General* ; Anesthetics ; Esotropia ; Exotropia ; Humans ; Strabismus

There are many factors that influence the response of strabismus surgery. This study was undertaken to evaluate the influence of axial length on the response to strabismus surgery. Axial length was determined preoperatively on 156 non-paralytic horizontal strabismus patients undergoing strabismus surgery from February, 1993 to April, 1994. The mean axial length in all patients was 22.29+/-1.35mm. In esotropia the mean axial length was 21.24+/-1.12mm and in exotropia the mean axial length was 22.68+/-1.23mm. A statistically significant inverse correlation was found between axial length and surgery response (prism diopters per millimeter of recuts recession) in esotropic patients (R=-0.51 p=0.0006). Especially in aquired esotropia, a more significant correlation was found between axial length and surgery respinse (R=-0.73 P=0.0001). The relationship in esotropia was linear and could be written as the approximate regression formula : surgery response=9.51-0.29* axial length (R=-0.454 P=0.03). However, a poor correlation was found between axial length and surgery response in exotropia. Therefore it is regraded as being effective that the amount of recession in esotropia should be graduated according to axial length.
Esotropia ; Exotropia ; Humans ; Strabismus*