Purpose: We report the postoperative results of a two stage surgical procedure for bilateral sixth nerve palsy with large-angle esotropia due to a traumatic event. Case summary: A 66-year-old female had a traffic accident and sustained a subdural hemorrhage. After the accident, the patient complained of diplopia. Using the Krimsky test, large-angle esotropia of about 90 prism diopters at the primary position, and -6 limitation of lateral gaze eye movement were observed in both eye. At 14 months after the accident, we performed medial rectus recession and augmentation of the superior rectus, and inferior rectus transposition at the lateral rectus insertion along the spiral of Tillaux in a two stage surgical correction. Two months after the second operation, the patient’s eye alignments showed slight exophoria of about 2 prism diopters at the primary position on the far and near alternate prism cover test. Abduction and adduction limitations of -1 were found in both eyes and her diplopia had disappeared. Conclusions We report a case of bilateral sixth nerve palsy with large-angle esotropia due to trauma. Although it was difficult to predict the surgical outcome, two stage surgery provided a stable surgical result, and additional sutures between the transposed muscle and the lateral rectus muscle, resulted in improvement of the abduction disorder.

Purpose: To analyze the therapeutic effects, prognostic factors, and complications that occurred after iStent® or iStent inject® implantation in South Korean glaucoma patients. Methods: We retrospectively analyzed 42 eyes of South Korean glaucoma patients, who were followed-up for more than 6 months after iStent® or iStent inject® implantation alone or combined with cataract surgery. Surgical success was defined as an intraocular pressure (IOP) ≤21 mmHg and an IOP reduction ≥20% from preoperative IOP levels. Results: The cumulative success rate at 6 months after surgery was 45.3 ± 8.1% for iStent inject® alone (group A), 28.6 ± 13.1% for iStent® alone (group B), 81.2 ± 6.8% for iStent inject® combined with cataract surgery (group A-1), and 27.3 ± 21.8% for iStent® combined with cataract surgery (group B-1). Group A-1 showed a higher success rate than group B-1 (p = 0.007); the difference in success rates between groups A and B was not statistically significant (p = 0.579). When the success prognostic factors were analyzed by Cox regression analysis, the results showed that a higher preoperative IOP was associated with a higher surgical success rate (hazard ratio 0.80, p = 0.02). Conclusions In our patient group, iStent inject® was more effective than iStent® in combination with cataract surgery. The higher the preoperative IOP, the higher the surgical success rate; the results were significant.

Purpose: We report the postoperative results of a two stage surgical procedure for bilateral sixth nerve palsy with large-angle esotropia due to a traumatic event. Case summary: A 66-year-old female had a traffic accident and sustained a subdural hemorrhage. After the accident, the patient complained of diplopia. Using the Krimsky test, large-angle esotropia of about 90 prism diopters at the primary position, and -6 limitation of lateral gaze eye movement were observed in both eye. At 14 months after the accident, we performed medial rectus recession and augmentation of the superior rectus, and inferior rectus transposition at the lateral rectus insertion along the spiral of Tillaux in a two stage surgical correction. Two months after the second operation, the patient’s eye alignments showed slight exophoria of about 2 prism diopters at the primary position on the far and near alternate prism cover test. Abduction and adduction limitations of -1 were found in both eyes and her diplopia had disappeared. Conclusions We report a case of bilateral sixth nerve palsy with large-angle esotropia due to trauma. Although it was difficult to predict the surgical outcome, two stage surgery provided a stable surgical result, and additional sutures between the transposed muscle and the lateral rectus muscle, resulted in improvement of the abduction disorder.

Purpose: To analyze the therapeutic effects, prognostic factors, and complications that occurred after iStent® or iStent inject® implantation in South Korean glaucoma patients. Methods: We retrospectively analyzed 42 eyes of South Korean glaucoma patients, who were followed-up for more than 6 months after iStent® or iStent inject® implantation alone or combined with cataract surgery. Surgical success was defined as an intraocular pressure (IOP) ≤21 mmHg and an IOP reduction ≥20% from preoperative IOP levels. Results: The cumulative success rate at 6 months after surgery was 45.3 ± 8.1% for iStent inject® alone (group A), 28.6 ± 13.1% for iStent® alone (group B), 81.2 ± 6.8% for iStent inject® combined with cataract surgery (group A-1), and 27.3 ± 21.8% for iStent® combined with cataract surgery (group B-1). Group A-1 showed a higher success rate than group B-1 (p = 0.007); the difference in success rates between groups A and B was not statistically significant (p = 0.579). When the success prognostic factors were analyzed by Cox regression analysis, the results showed that a higher preoperative IOP was associated with a higher surgical success rate (hazard ratio 0.80, p = 0.02). Conclusions In our patient group, iStent inject® was more effective than iStent® in combination with cataract surgery. The higher the preoperative IOP, the higher the surgical success rate; the results were significant.