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

PURPOSE: The purpose of this study was to find stability and histological change after resection of extraocular muscle by suturing the proximal and distal muscle segments end to end for elimination of the risk of scleral perforation in the rabbit. METHODS: After dividing rabbits into two groups, we performed the resection of superior rectus muscle. The control group (18 eyes) was treated with conventional operation method in which we placed sutures directly into sclera after resection of muscle, whereas in the experimental group (18 eyes) sutures were placed between proximal and distal muscle segments end to end, without scleral suture, after resection of muscle 3 mm behind the original insertion. We measured the maximum adhesion power at 1day, 1-, 4-, and 8-week postoperative intervals and observed the histopathologic findings at 4- and 8-week postoperative intervals in both groups. RESULTS: In both groups, the maximal adhesion power increased gradually with time at muscle-to-sclera and muscle-to-muscle adhesion site and reached its highest at 8th week. According to histopathologic findings, chronic inflammatory reaction and foreign body reaction were more severe in the experimental group at 4th week, but disappeared at 8th week in both groups. Fibrosis was slightly more severe in the experimental group. CONCLUSIONS: In resection of extraocular muscle for correction of strabismus, muscle-to-muscle suture is thought to be stable and effective way to avoid scleral perforation for the patient whose sclera is thin or abnormal.
Fibrosis ; Foreign-Body Reaction ; Humans ; Inflammation ; Rabbits ; Sclera ; Strabismus ; Sutures*

Management of infantile and early childhood onset strabismus should be completed during early childhood to gain better binocular function and vision. The author experiencep 38 adult patients who had horizontal strabismus without any adequate treatment lasting over 14 years with onset before 6 years of age. They showed large angle of deviation and deep amblyopia. After surgery, stereopsis was never developed in all of the 14 congenital strabismic patients, whereas 30% of the 24 patients with acquired onset showed gross stereopsis. There was abnormal muscular contracture requiring adjustable stutre. All of the patients showed abnormal character psychologically. This study revealed that the longer the duration of misalignment, the greater the chance of deep amblyopia, large angle of deviation, abnormal sensory and motor adaptation, psychological influence, and abnormal muscular contracture. Therefore early initiation of therapy during early childhood should be emphasized.
Adaptation, Psychological ; Adult* ; Amblyopia ; Contracture ; Depth Perception ; Humans ; Strabismus* ; Telescopes

Management of infantile and early childhood onset strabismus should be completed during early childhood to gain better binocular function and vision. The author experienced 38 adult patients who had horizontal strabismus without any adequate treatment lasting over 14 years with onset before 6 years of age. They showed large angle of deviation and deep amblyopia. After surgery, stereopsis was never developed in all of the 14 congenital strabismic patients, whereas 30% of the 24 patients with acquired onset showed gross stereopsis. There was abnormal muscular contracture requiring adjustable stutre. All of the patients showed abnormal character psychologically. This study revealed that the lunger the duration of misalignment, the greater the chance of deep amblyopia large angle of deviation, abnormal sensory and motor adaptation, psychological influence, and ahnormal muscular contracture. Therefore early initiation of therapy during early childhood should be emphasized.
Adaptation, Psychological ; Adult* ; Amblyopia ; Contracture ; Depth Perception ; Humans ; Strabismus* ; Telescopes

In this study, 63 patients underwent unilateral or bilateral medial rectus recession for nonaccommodative portion of partially accommodative esotropia and were followed up for more than 2 years after surgery.The nonaccommodative portion was measured by wearing the least hyperopic glasses for the best corrected visual acuity.The amount of recession of medial rectus was determined considering the patients'characteristics such as fusional ability, amount of hyperopia, AC/A ratio, visual acuity, and quality of muscle at forced duction test. The mean follow-up period was 5.2 +/-2.53 (2~13)years.Seven (11.2%) patients underwent surgery for recurrent esotropia due to deterioration. Consecutive exotropia did not occur.At the last visit all eyes were aligned with favorable stereopsis.Forty eight patients (76.2%)had deviation up to 8 PD of orthophoria and 15 patients showed esophoria greater than 8 PD, with fusional ability and stereoacuity of 40~400 seconds of arc (sec).Preoperatively, only 28.1%of the patients had gross stereopsis of 200~3000 sec.Postoperatively, 98.6%of the patients showed good stereopsis better than 800 sec : 75.5%better than 200 sec and 76%normal stereopsis more than 40 sec. This study revealed that individualized surgery for nonaccommodative component, and meticulous pre-and postoperative management resulted in good alignment and binocularity during long-term follow-up.Recurrent esotropia due to detrioration occurred more than consecutive exotropia after surgery.
Depth Perception ; Esotropia* ; Exotropia ; Eyeglasses ; Follow-Up Studies ; Glass ; Humans ; Hyperopia ; Telescopes* ; Visual Acuity

It. has been reported that, subconjunctival mitornycin c is strongiy effective in the reduction of postoperative fibrosis and adhesion. However we have to be cautious in using it clinically because of severe complications, scleral necrosis, endophthalmitis, etc. To find out the adequate concentration of mitomycin C, the authors performed 3mm recession of the superior rectus muscle (SR) in the left sys of 24 rabbits which were divided into 4 groups. Each group was composed of 6 rabbits. The 0.1%of 0.9% normal saline, 0.005% 0.01%, and 0.02% mitomycin c were injected subcounctivally through the site of SR recession in each group, respectively. The severity of the adhesion between SR and its surrounding tissues and the reduction of fibroblast. proliferation were evaluated histopathologically with the light microscope one month after surgery. The 0.01% and 0.02%mitomycin C-injected groups demonstrated considerable inhibition of postoperative adhesion and fibroblastic proliferation (p<0.05 and P<0.01, respectively) . However the 0. 005% mitomycin c was not. effective in the reduction of postoperative adhesion (P>0. 15), This study reveals that the concentration of mitomycin c between 0.01% and 0.02% may prevent postoperative adhesions effectively after strabisrnus surgery. Further studies are needed to demonstrate the lowest concentration of mitoniycin c to prevent postoperative adhesion effectively without any com.plicat.ions in clinical use.
Endophthalmitis ; Fibroblasts ; Fibrosis ; Mitomycin* ; Necrosis ; Rabbits

Good compliance of patching therapy is essential to improve visual acuity in amblyopia. The author investigated the compliance and effective method of occlusion therapy for amblyopia by questionair given to the patients and their parents. For better compliance and the duration of patching and the best time for its performance should be controlled according to patients' character and age. It was shown that the younger the age, the better the compliance of patching therapy. It was important that early diagnosis for amblyopia made and early treatment should be initiated before 6 years of age, beeause the compliance of patching therapy was much decreased in patients above six years of age. Physicians should ensure full understanding of amblyopia in patients and their parents, especially mothers, before patching therapy begins. Continued and steady patching could considerably improve visual acuity in ehildren older than eight years of age.
Amblyopia* ; Compliance* ; Early Diagnosis ; Humans ; Mothers ; Parents ; Visual Acuity

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