Long-term surgical results for 3 or 4 horizontal muscles surgery were evaluated in 58 infantile esotropes with large angle of 55 PD or more. They were followed up for 2 years or more(mean 5.6+/-2.16 years). The mean preoperative deviation was 63.2(+/-5.30)PD, ranging from 55 to 75 PD. Monocular preference was shown in fifty seven percent(34 patients)at the first visit. Thirty eight patients(65.5%)were aligned within+/-8 PD of orthotropia after primary procedure and forty nine patients(84.5%)after the second operation. The immediate postoperative deviation averaged 4.8+/8.99 PD of exotropia in 38 patients all of whom were aligned within+/-8 PD of orthotropia at the last visit. Prospectively, the patients with immediate overcorrection of 4 to 9 PD of orthotropia after surgery were found to be mostly aligned within 8 PD of orthotropia at the last visit. Among the 49 patients with stereopsis testing, 29 patients(58%)had measurable stereopsis and 70%of these patients had favorable stereopsis of 800 seconds or less. In conclusion, 3 or 4 horizontal muscles surgery was effective as initial procedure in large angle infantile esotropia with 55 PD or more deviation. Small amount of exotropia less than 10 PD in the immediate postoperative period was desirable for the best long-term alignment.
Depth Perception ; Esotropia* ; Exotropia ; Humans ; Muscles* ; Postoperative Period ; Prospective Studies

The histopathological changes were observed to evaluate the effect of single intraopferative application of mitomycin C soaked Cottonoid on wound healing process after strabismus surgery. A 3mm recession of the superior rectus muscle was performed after application of 0.5mg/ml mitomycin C soaked Cottonoid for 5 minutes in one eye of 15 rabbits(30 eyes) and was copiously irrigated with normal saline. The same procedure was done in the contralateral eye as a control using normal saline. The less amount of inflammatory cellular infiltration and the less granulomatous reaction to suture material were observed in mitomycin C treated eyes. The proliferation of fibroblast was considerably inhibited in mitomycin C-treated group. The postoperative adhesion, the fibrosis of extrocular muscle and the depositon of collagen fibers were also decreased in mitomycin C-treated group. Gross complications was not present in rabbit during 3 months of experiment. No pathologic sign of undesirable side effects was noted. In conclusion, the single intraoperative application of mitomycin C soaked Cottonoid could decrease the postoperative adhesion and extraocular muscle fibrosis through its inhibitory effects on the inflammatory reaction and fibroblast proliferation in strabismus surgery without any complications which were reported in subconjunctival injection of mitomycin C. Further studies investigating the optimal concentration, application method and time of mitomycin C soaked Cottonoid and its promising potential for use in humans are needed.
Collagen ; Fibroblasts ; Fibrosis ; Humans ; Mitomycin* ; Strabismus ; Sutures ; Wound Healing* ; Wounds and Injuries*

The commonly used tests for stereopsis are Titmus-fly, Randot, and TNO tests. In this study, 50 normal subjects were tested with these tests in order to set a criterion for normal stereopsis. The value of mean, mode and 75% point of these three tests were derived and compared.These three tests were also performed in 23 intermittent exotropes and 32 accommodative esotropes who showed gross stereopsis in the range of 60 to 400 seconds of arc by Titmus-fly testing. The aim was to obtain standards for clinical applicability and accuracy of these tests.This study cincludes that the appropriate criteria for normal stereopsis are less than 60 seconds of arc for Titmus-fly or Randot test, and 120 seconds of arc fot TNO test. Accurate testing for stereopsis in patients with gross stereopsis requires both Titmus-fly and Randot tests together. TNO test was inferior to the other two tests in terms of the accuracy and clinical applicability.
Depth Perception ; Humans

Anterior segment ischemia(ASI) may be caused by a detachment of the rectus muscles from the globe. The interruption of the anterior ciliary artery by the detachment of rectus muscles causes a subsequent hypoperfusion to the anterior segment. ASI occurs more easily after surgery on the vertical rectus or after detachments of two or more adjacent rectus muscles. We experienced two patients with ASI after performing muscle surgery on them for lateral rectus muscle palsy caused by a traffic accident. A 5-year-old-male developed keratitis and uveitis following a Hummelsheim operation in combination with a lateral rectus resection in his right eye. A 51-year-old female showed keratitis, uveitis and pupilary distortion after a Knapp procedure combined with a lateral rectus tucking in her right eye. Both patients recovered without any complications.
Accidents, Traffic ; Ciliary Arteries ; Female ; Humans ; Ischemia* ; Keratitis ; Middle Aged ; Muscles ; Paralysis ; Strabismus* ; Uveitis

Anterior segment ischemia syndrome is caused by disruption of anterior ciliary vessels at surgery on multiple rectus muscles in strabismus. Staging surgery has been recommended when more than 3 rectus muscles are to be tenotomized. The purpose of this study is to prevent anterior segment ischemia syndrome using the technique of anterior ciliary vessels under the surgical microscope, and correct paralytic and complicated strabismus at one surgery. Six patients underwent preservation of anterior ciliary vessels. Five patients had sixth nerve palsy in one eye. First, superior and inferior rectus muscles were transposed, then medial rectus was recessed with preservation of anterior ciliary vessels. Four were successful, but one was failed and needed second operation. Another patient showed exotropia and hypetropia of amblyopic eye, in which recession of lateral rectus and resection of medial rectus, and recession of superior rectus with preservation of its anterior ciliary vessels were performed. All the patients showed orthoporia without anterior segment ischemia. This study suggests that the preservation of anterior ciliary vessels of rectus muscles is a very delicate and time-consuming procedure, but effective in preventing anteior segment ischemia syndrome and reducing the number of surgery.
Abducens Nerve Diseases ; Exotropia ; Humans ; Ischemia ; Muscles ; Strabismus*

PURPOSE: To evaluate morphological differences in proprioceptors in extraocular muscles between congenital exotropia, acquired exotropia and congenital nystagmus. METHODS: Nine medial recti including the myotendinous junction were resected using medial rectus resection in three congenital and five acquired exotropia patients. Two medial recti and two lateral recti were resected using the modified Kestenbaum procedure in two congenital nystagmus patients. The muscle tissues were examined under a light microscope following examination with a transmission electron microscope. RESULTS: In the congenital exotropia group, the electron microscopic findings showed degenerative changes in proprioceptors, such as decreased microtubules, axonal shrinkage and decreased myelin thickness. In the acquired exotropia group, the neural structures in the myotendinous junction were well maintained. There were no neural structures in the myotendinous junction in the congenital nystagmus group. CONCLUSIONS: Depending on the type of strabismus, there may be morphological differences in proprioceptors of extraocular muscles.
Axons ; Exotropia* ; Humans ; Microtubules ; Muscles* ; Myelin Sheath ; Nystagmus, Congenital* ; Strabismus

Many surgeons prefer to postpone surgery of intermittent exotropia after 4 years of age because small angle esotropia, amblyopia and sensory anomaly could be caused by early surgery. The purpose of this paper is to determine whether the nonsurgical treatment is effective to delay surgery in intermittent exotropes less than 4 years of age. Short-time patching for 3-4 hours (patching) was performed in 39 children and compared to those with patching combined with overcorrecting minus glasses added by minus power between 1.00 and 2.75D (combined therapy) in 21 children. Before treatment, the average amount of exo-deviation in 60 patients was 29.4 prism diopters(PD) at distance and 23.4 PD at near at initial visit. The improvement of 6 PD or more in exodeviation was obtained in 32 patients(82.1 %) with the patching and 20 patients(95.2%) with the combined therapy. After treatment, the average amount of improved exo-deviation with the patching group was 7.9 PD at distance and 13.5 PD at near, while it was 8.9 PD at distance and 16.9 PD at near with the group that received the combined therapy. The improvement in exodeviation was greater at near than at distance, and greater in paitents treated with the combined therapy than in patients with the patching. In conclusions, surgery can be delayed effectively with the 3-4 hours patching and the small amount of overcorrecting minus glasses in young intermittent exotropes less than 4 years of age, in light of considerable reduction of exoangle and frequency of exodeviation.
Amblyopia ; Child* ; Esotropia ; Exotropia* ; Eyeglasses ; Glass ; Humans

We selected 16 patients who had high myopia more than -6.00D (diopters) in an amblyopic eye and showed refractive difference more than 5.00D between both eyes. All patients had axial myopia and could wear glasses to full correction without any discomfort. Patching or patching combined with atropine penalization was done as antiamblyopia management. Twelve of 13 patients had improved visual acuity after wearing glasses to full correction with antiamblyopia treatment. Six of 8 children older than 8 years of age also showed considerable improvement in visual acuity. This study reveals that axial high myopic anisometropes who have a big difference more than 5.00D between both eyes, can wear glasses to full correction without any discomfort. Vigorous antiamblyopia treatment was essential to improve visual acuity in children morethan 4 years of age, even in older patients between 9 and 14 years of age.
Amblyopia* ; Anisometropia ; Atropine ; Child ; Eyeglasses ; Glass ; Humans ; Myopia ; Visual Acuity

It is known that early surgery between 6 and 24 months of age obtains better binocularity in infantile esotropia. We selected 59 patients who had infantile esotropia with onset before 6 months of age and underwent surgery at 10 years of age or less. Stereopsis was tested in 51 patients after surgery. Thirty four patients(66.7%) showed gross stereopsis. The patients who underwent surgery at 2 years of age or less, developed gross stereopsis in 80.8%. The patients who had their eyes aligned their eyes between 2 and 4 years of age, gross stereopsis was demonstrated in 64.3%, white the patients underwent surgery more than 4 years of age developed gross stereopsis in 36.3%. The younger the patients at the time of surgery, the greater the percentage of gross stereopsis was shown(p<0.05). Orthophoria(within +/-10 prism diopters) was seen in 81.3% of the patients underwent surgery at 2 years of age or less and in 59.3% of the patients underwent surgery more than 2 years of age(p>0.05). This study revealed that early surgery, before 2 years of age, yields better outcome for sensory fusion and good alignment.
Depth Perception ; Esotropia* ; Humans ; Telescopes

The use of succinylcholine chloride(Anectin(R)) prior to intubation, can cause increased contracture of ocular muscles. Therefore the authors studied the change of the squint angle under general anesthesia using pancronium bromide (Myoblock(R)) in 81 horizontal strabismus patients who had no neurologic disease and mechanical restrictions of eye movement. We used the alternative cover test and Krimsky method to measure the eye position under general anesthesia.
Anesthesia ; Anesthesia, General* ; Contracture ; Eye Movements ; Humans ; Intubation ; Muscles ; Strabismus* ; Succinylcholine