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*

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 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

The authors report two cases of suddenly deteriorated accommodative esotropia with amblyopia during part-time occlusion therapy. A 7-year-old girl with right accommodative esotropia, which was well controlled, showed marked increase in esodeviation after part-time occlusion and regained orthophoria without occlusion. This phenomenon was repeated. Recession of both medial recti was performed and orthophoria was well maintained at both distant and near targets. Accommodative esotropia of a 9-year-old boy with glasses also showed a striking increase in esodeviation after part-time occlusion. The authors recommended wearing only glasses without occlusion or surgery and he recovered fusion. Three months later, orthophoria was maintained at distant target, with 8PD esophoria at near target with glasses. Although this complication should be considered before occlusion therapy, it must be taken continuously if needed, because an increase of the deviation size with occlusion may simply reflect a true deviation and may not be a poor prognostic sign.
*Accommodation, Ocular ; Amblyopia/physiopathology/therapy ; Child ; Esotropia/*etiology/physiopathology ; Eyeglasses ; Female ; Humans ; Male ; *Sensory Deprivation

To verify the postoperative ultrastructural changes of the myotendinous nerve endings of feline extraocular muscles, which are known as proprioceptors. Sixteen recti of four cats were used and divided into three groups. In group A, eight lateral recti were recessed. In group B, four medial recti were resected by 10 mm from insertion to include the myotendinous junction. In group C, four medial recti were resected by 4 mm of muscle bellies only, without disturbing the myotendinous junction. Four weeks after surgery, specimens were examined with electron microscopy. In group A, overall neural structures were well maintained with slight axonal degeneration. In group B, only muscle fibers were observed without any regeneration of neural sprouts. In group C, axonal disintegration and shrinkage were evident. These results indicate that myotendinous nerve endings can be damaged in strabismus surgery, and that resection was more invasive than recession in disrupting myotendinous nerve endings.
Animals ; Cats ; Motor Neurons/ultrastructure ; Nerve Endings/*ultrastructure ; Neuromuscular Junction/*ultrastructure ; Oculomotor Muscles/*innervation/surgery ; Oculomotor Nerve/*ultrastructure ; *Ophthalmologic Surgical Procedures ; Receptors, Sensory/ultrastructure ; Strabismus/surgery ; Tendons/*innervation/ultrastructure

PURPOSE: The purpose of this study is to provide useful clinical information for proper diagnosis of the superior oblique muscle palsy (SOP) associated with horizontal deviation. METHODS: The records of 186 patients with SOP treated surgically were reviewed. The patients who underwent surgery for horizontal deviation more than 10 PD were classified into SOP associated with horizontal deviation. RESULTS: Of 186 patients with SOP, 96 (51.6%) patients also showed horizontal deviation. In 59 patients (61.5%) of these 96 patients, chief complaint was horizontal deviation only and 24 patients (25.0%) knew their hyperdeviation. Compensatory head-tilt was shown in 52 patients (54.2%), however only 11 (11.5%) patients complained their head-tilt posture. Of 96 patients, 72 (82.3%) had horizontal deviation in the eye contralateral to the paretic eye and amblyopia occurred in the horizontally deviated eye. The frequency of exodeviation was 82.3 % and was more than that of esodeviation. The mean amount of hyperdeviation was 12.6 +/- 6.77 PD, and that of horizontal deviation was 22.9 +/- 8.13 PD in exodeviation and 22.5 +/- 9.17 PD in esodeviation, respectively ninety three patients (96.9%) showed positive Bielschowsky head-tilt test. All 83 patients who had fundus examination showed foveal extorsion. CONCLUSIONS: This study reveals that Bielschowsky head-tilt test and fundus examination for foveal extorsion are needed to diagnose SOP which is masked by prominent horizontal deviation.
Amblyopia ; Diagnosis ; Esotropia ; Exotropia ; Humans ; Masks ; Paralysis ; Posture

In amblyopes with visual acuity less than 0.1, it is very hard to obtain visual improvement by antiamblyopia treatment. They show very poor compliance with patching of good eye due to severely blurted vision of amblyopic eye. We experienced 29 children who showed strabismic amblyopia with vision less than 0.1. The treatment includes glasses, patching or patching combined with atropine penalization of good eye, and surgery for strabismus in some cases. The average improvement of visual acuity in 29 children was 4 lines on viusal acuity chart. Twenty three out of 29 patients(79%) obtained visual acuity of 0.3 or more. Among 6 patients who could not show good visual outcome, 5 patients had been lazy in patching therapy. The improvement of visual acuity was not influenced by age of the patients, severity of refractive error and angle of deviation, but compliance with patching. This study reveals that the vigorous and steady patching could considerably improve visual acuity in severe amblyopia, and also needs full understanding and effort of patients, parents and physicians to gain satisfactory result.
Amblyopia* ; Atropine ; Child ; Compliance ; Eyeglasses ; Glass ; Humans ; Parents ; Refractive Errors ; Strabismus ; Visual Acuity

PURPOSE: To evaluate the main symptoms and associated ocular diseases in patients with dyslexia (reading difficulty) in Korean subjects. METHODS: A total of 16 patients were enrolled in the present study. Eleven of the patients with Meares-Irlen syndrome whose symptoms improved with tinted lenses comprised Group 1. The other 5 patients whose reading difficulty improved with other ocular therapy and did not require tinted lenses comprised Group 2. The main symptoms causing dyslexia and associated ocular diseases were evaluated. RESULTS: The mean age was 18.9 +/- 8.9 years in Group 1, and 20.4 +/- 12.3 years in Group 2. In Group 1, the most common symptoms while reading were doubling (72%), difficulty to move lines (46%), letter reversal (27%) and blurring or ocular pain (27%). On the other hand, blurring (100%) with fatigue or pain (20%) was documented in Group 2. The associated ocular diseases in Group 1 and Group 2 were refractive error (63% and 20%), dry eye (18% and 60%), and exophoria (18% and 60%), respectively. CONCLUSIONS: Doubling and difficulty to move lines while reading were the main specific symptoms in Meares-Irlen syndrome in the present study. Refractive error, dry eye, and exophoria were commonly associated in patients with dyslexia.
Dyslexia ; Exotropia ; Eye ; Fatigue ; Hand ; Humans ; Korea ; Refractive Errors

PURPOSE: To report a male infant with bilateral Duane's retraction syndrome treated with bilateral horizontal transpositions of vertical recti to the lateral rectus muscle. METHODS: An 8-month-old boy showed bilateral Duane's retraction syndrome with esotropia of 45PD, severe limitation of abduction (-4 and -3.5 in each eye) and mild globe retraction in both eyes. It was assumed that he inherited the condition from his father through an autosomal dominant pattern. His father showed esotropia of 25PD with -4 limitation of abduction in the left eye and a left head-turn of 10 degrees. He also had +2 globe retraction, +1 upshoot and +2 downshoot in adduction of the left eye. Transposition of two vertical recti to the lateral rectus muscle was performed in both eyes of the boy. RESULTS: Nine months after surgery, the boy had achieved a microesotropia of 6PD in primary gaze with stereopsis of 3000 seconds of arc and considerable improvement in abduction (-2, -1.5 in each eye). The amount of correction of esodeviation was 39PD. This favorable state was maintained at follow-up 3.5 years after surgery. CONCLUSIONS: An 8-month-old boy who had esotropia of 45PD caused by bilateral Duane's retraction syndrome, underwent bilateral horizontal transpositions of vertical recti to the lateral rectus muscle. He achieved a microesotropia of 6PD in primary gaze and considerable improvement of abduction with only mild eyeball retraction.
Depth Perception ; Duane Retraction Syndrome* ; Esotropia ; Fathers ; Follow-Up Studies ; Humans ; Infant ; Male

We identified facial asymmetry in 81 patients with a history of long standing head tilt due to congenital or early childhood onset superior oblique palsy(SOP). To determine facial asymmetry, full frontal photographs of face were taken for each patient in a straight ahead position. They were also evaluated for skull molding, sleeping habit and degree of head tilt. Facial asymmetry was noted in 62 of 81(76.5%) patients with early onset superior oblique palsy. Eighteen of 36(50%) patients with facial asymmetry had skull molding and sleeping habit to lay down on the one side of head. Incidence of facial asymmetry was high in patients with head tilt. In addition, one of 3(33.3%) patient less than 24 months of age showed constant head tilt and facial asymmetry. After surgical correction of superior oblique palsy, head tilt was eliminated and facial asymmetry gradually disappeared. Facial asymmetry was found in 5 of 9(55.6%) patients between 2 and 3 years of age, and in 25 of 28(89.3%) patients more than 3 years of age. Fortunately it gradually improved at the long term follow-up. This study shows that the facial asymmetry cold be produced by chronic head tilt from even less than 2 years of age. Skull molding may develop in infants who prefer to sleep on one side of head. To prevent the development of facial asymmetry, early surgery less than 2 years of age may be needed. Monitoring of head position during sleep may be important to prevent skull molding. If head tilt persist even after surgical correction of SOP, secondary scoliosis, contracture of the neck muscle or habit should be considered and physical therapy may be needed.
Contracture ; Facial Asymmetry* ; Follow-Up Studies ; Fungi ; Head* ; Humans ; Incidence ; Infant ; Neck Muscles ; Paralysis* ; Scoliosis ; Skull