We attempted to predict the success, undercorrection, overcorrection rate at postoperative 1 year by examining alignment at postoperative 1 day and find out the relationship between alignment of postoperative 1 day and 1year. Forty-six patients with intermittent exotropia underwent bilateral lateral rectus recession at Keimyung university, Dongsan medical center and fifty-seven patients underwent unilateral medial rectus resection and lateral rectus recession at Catholic university, St.Mary`s hospital. The alignment at postoperative 1 day was classified as the overcorrected with 11-20PD, the overcorrected with 1-10PD,the orthotropia, and the undercorrected with residual exotropia of 1-10PD. There was a statistically significant relationship between alignment at postoperative 1 day and 1 year in unilateral medial rectus resection and lateral rectus recession and bilateral lateral rectus recession (r=0.74, r=0.51, p<0.05). Those patients who were overcorrected 1-20PD had a significantly higher success rate than those undercorrected 1-10PD at postoperative 1 day (p<0.05). In the unilateral medial rectus resection and lateral rectus recession group,postoperative 1 day alignment of 1-10PD resulted in the highest success rate of 73.7%. In the bilateral lateral rectus recession group,postoperative 1 day alignment of 11-20PD showed the highest success rate of 76.9%. There were no significant differences in the success rate,undercorrection rate, and overcorrection rate between the two kinds of surgery at postoperative 1 year. As a result, the alignment at postoperative 1 day can be one of the predictive factors of future surgical outcome. The initial postoperative overcorrection of 11-20PD in bilateral lateral rectus recession and overcorrection of 1-10PD in unilateral medial rectus resection and lateral rectus recession can lead to good results.
Exotropia ; Humans

PURPOSE: This study examines the change in distance from the corneal limbus to the insertion of the rectus muscles before and after disinsertion and retraction with a pair of fixation forceps during strabismus surgery. METHODS: In 38 strabismus patients, on 30 medial rectus muscles and 38 lateral rectus muscles, before and after disinsertion and retraction with a pair of fixation forceps, the distances from the corneal limbus to the upper, middle and lower parts of the insertion of the medial and lateral rectus muscles marked with methylene blue solution were measured. RESULTS: The distances between the corneal limbus and upper, middle and lower parts of the insertion after the disinsertion were reduced on, average 0.23 mm, 0.28 mm, and 0.18 mm, for the medial rectus muscle, respectively, and 0.21 mm, 0.28 mm, and 0.15 mm, for the lateral rectus muscle, respectively (P<0.05). The percentage of cases in which the advance from the corneal limbus to the insertion was greater than 0.5 mm was 33.3% for the medial rectus muscle, and 21.1% for the lateral rectus muscle. The lateral rectus muscle was disinserted, fixed with a pair of forceps, and subsequently, the distance from the upper, middle and lower parts to the corneal limbus were reduced to 0.36 mm, 0.43 mm, and 0.30 mm, respectively (P<0.05). The percentage of cases that advanced more than 1.0 mm was 13.2 %. The changes in distance from the upper, middle, and lower parts of insertion toward the limbus after disinsertion and retraction were 0.15 mm 0.15 mm, 0.16 mm, respectively (P<0.05). CONCLUSIONS: When performing the recession of the lateral rectus muscle, disinsertion of the rectus muscle, may result in a change of the site of insertion, which in turn might influence the outcome of strabismus surgery.
Humans ; Limbus Corneae ; Methylene Blue ; Muscles* ; Strabismus ; Surgical Instruments

No abstract available.
Humans*

No abstract available.
Paranasal Sinus Neoplasms*

PURPOSE: We report a case of Type 3 Waardenburg syndrome accompanied by intermittent exotropia, which had not previously been encountered in Korea along with the literature study. METHODS: A 5-year-old boy visited as a result of hypochromic heterochromic iridum in the right eye. Suspecting Type 3 Waardenburg syndrome, plain radiography, a hearing test, an alternate prism cover test and fundus examinations were performed and the presence of lateral displacement of the lacrimal puntum was evaluated. RESULTS: The presence of hypochromic heterochromic iridum, dysplasia of the left thumb, sensorineural deafness, dystopia canthorum along with a lateral displacement of the lacrimal puntum, albinism of the posterior pole upon a fundus examination, and intermittent exotropia with a 20 prism diopters of deviation were found. CONCLUSIONS: This patient showed the 4 criteria for a diagnosis of Type 3 Waardenburg syndrome including hypochromic heterochromic iridum, dystopia canthorum along with lateral displacement of the lacrimal puntum, sensorineural deafness, and a muscular system abnormality, i.e., dysplasia of the left thumb. He also showed intermittent exotropia.
Albinism ; Child, Preschool ; Deafness ; Diagnosis ; Exotropia ; Hearing Tests ; Humans ; Korea ; Male ; Radiography ; Thumb ; Waardenburg Syndrome*

PURPOSE: To investigate the clinical outcomes of unilateral lateral rectus muscle advancement in patients with consecutive esotropia after bilateral lateral rectus muscle recession. METHODS: We investigated the results of 13 patients who underwent unilateral lateral rectus muscle advancement for consecutive esotropia after bilateral lateral rectus muscle recession. We evaluated the amount of deviation, changes of angle deviation, corrected amount/mm, and sensory status after each surgery. RESULTS: The average angle deviation of exotropia was 30.42+/-5.41PD, and the average amount of bilateral lateral rectus muscle recession was 6.73+/-0.59 mm. The average angle deviation of esotropia one day after the surgery was 13.17+/-5.15PD. Occlusion treatment was performed during follow-up. The surgery for consecutive esotropia was performed after an average of 12.0+/-7.25 months of follow-up. In Worth-4-dot tests, 12 patients showed diplopia, and 1 patient showed suppression after the surgery for exotropia. Nine patients showed diplopia, and 4 patients showed suppression just before the surgery for consecutive esotropia. One patient showed mild limitation of motion of the lateral rectus muscle (-1 degree). The average angle deviation before the surgery for consecutive esotropia was 19.42+/-4.20PD. An average of 6.73+/-0.79 mm of unilateral lateral rectus muscle advancement was performed. After surgery, the average angle deviation was 1.25+/-2.73PD esodeviation, and 1.42+/-4.44PD exodeviation after 6 months. In Worth-4-dot tests, 6 patients showed fusion, 2 patients showed diplopia, and 5 patients showed suppression after surgery for consecutive esotropia. CONCLUSIONS: Unilateral lateral rectus muscle advancement was an effective procedure for patients with consecutive esotropia under 25PD who did not show any limitation of motion after bilateral lateral rectus recession.
Diplopia ; Esotropia ; Exotropia ; Follow-Up Studies ; Humans ; Muscles

PURPOSE: The purpose of this study is to evaluate sensory function and stereoacuity in patients showing orthophoria after surgery in exotropes, and to elucidate factors influencing postoperative improved sensory status METHODS: We prospectively studied 45 patients showing orthophoria or exophoria within 4 prism diopters after strabismic surgery in exotropes. Three tests (Worth-4-dot test, Bagolini striated lens test and Titmus test) were performed at pre and postoperative period. We studied the effect of different variables (age at surgery, visual acuity, angle of deviation, Bagolini striated lens test, Titmus test, anisometropia, and fusional status) with suspected clinical influence on the sensory and motor outcomes. RESULTS: In Worth-4-dot test, 34 patients (75.6%) showed improvement after surgery. Thirty-three patients (73.3%) and 35 patients (77.8%) showed improvement respectively in the Bagolini striated lens test and Titmus test. Thirty-eight patients showed improvement in 2 or more tests after surgery and 7 patients showed no change. Of patients showing preoperative abnormal response in each test, 21 patients (65.6%) in Worth-4-dot test, 14 patients (53.8%) in Bagolini striated lens test, and 22 patients (68.8%) in Titmus test showed normal response at postoperative 6 months. Of 3 tests and other factors, Bagolini striated lens test was the only factor predicting postoperative sensory recovery (x2=4.18, P<0.05). CONCLUSIONS: In patients showing orthophoria or exophoria within 4 prism diopters after strabismic surgery in exotropes, Bagolini striated lens test was the only meaningful factor predicting postoperative sensory recovery
Anisometropia ; Exotropia ; Humans ; Postoperative Period ; Prospective Studies ; Sensation ; Strabismus* ; Visual Acuity

PURPOSE: Surgeons perform either symmetrical lateral rectus recession or monocular recession of the lateral rectus and resection of the medial rectus (recession/resection procedure) in order to correct simulated divergence excess intermittent exotropia, X(T). We compared the results of these two procedures using surgical outcomes. METHODS: A total of 49 patients with simulated divergence excess X(T) were included in this study; among these 49, 32 underwent symmetrical lateral rectus recession and 17 underwent recession/resection procedure. Surgery was defined successful when the horizontal angle of deviation was within 8 prism diopters or less at distance and near at the last follow-up. RESULTS: The rate of success at the time of final follow-up was 68.8% in those who underwent symmetrical lateral rectus recession and 70.6% in those who underwent recession/resection procedure, showing no statistically significant difference between the two groups (p>0.05). Furthermore, there were also no significant differences in the undercorrection, overcorrection rates and the decrease in the deviation at distance and near between the two surgical procedures (p>0.05). CONCLUSIONS: No difference was present between the two methods examined in this study; thus, either of the two methods would be suitable for the correction of simulated divergence excess X(T).
Exotropia* ; Follow-Up Studies ; Humans

PURPOSE: To maximize effective use of mydriatic drugs through comparing the pupillary dilation effects between 1% tropicamide and 2.5% phenylephrine. METHODS: Fifty people requiring pupillary dilation were divided into 3 groups. Group 1 was treated with one drop of 1% tropicamide in the right eye and one drop of 2.5% phenylephrine in the left eye. Group 2 was treated twice during a 5-minute interval with 1% tropicamide in the right eye. Group 3 was treated twice during a 5-minute interval with 2.5% phenylephrine in the right eye. Groups 2 and 3 were treated with 2.5% phenylephrine and 1% tropicamide in the left eye, administered during a 5-minute interval. The pupillary size was measured in all groups for 40 minutes following eye drops administration. RESULTS: The mean patient age was 15.7 years. Group 1 included 10 patients, and groups 2 and 3 included 20 patients each. Eight patients in group 1 and 16 patients in group 2 developed a larger right pupil. Fourteen patients in group 3 developed a larger left pupil. CONCLUSIONS: Our study showed that 1% tropicamide, with its parasympathetic antagonistic mechanism of action, was more effective at inducing pupillary dilation than 2.5% phenylephrine, and the combination of 1% tropicamide and 2.5% phenylephrine was more effective than multiple drops of single eye drops.
Adolescent ; Adult ; Child ; Child, Preschool ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Humans ; Male ; Muscarinic Antagonists/*administration & dosage ; Mydriatics/*administration & dosage ; Ophthalmic Solutions ; Phenylephrine/*administration & dosage ; Pupil/*drug effects ; Refractive Errors/diagnosis/physiopathology ; Retrospective Studies ; Tropicamide/*administration & dosage ; Young Adult

PURPOSE: We report an example of successful operation of rare convergent strabismus fixus, which had previously been mistaken for orbital tumor in private clinics because of severe adduction with unseen cornea. METHODS: A 57-year-old woman had convergent strabismus fixus with inward deviation of the left eye that had gradually progressed since she was around 40. Her cornea was buried in the intraorbital rim. An eye movement examination revealed that the eyeball was fixed to the internal part and that eyeball movement was impossible in all directions. When the forced duction test was performed, strong resistance was shown in all directions when abducted. During surgery, the medial rectus muscle was disinserted after resection of 3.0 mm for the left eye, and lateral rectus muscle tucking of 11.0 mm for the left eye was conducted. Since there was resistance in the inferior oblique muscle by the forced duction test during the operation, inferior oblique muscle myectomy of 4.0 mm was simultaneously performed. RESULTS: In the forced duction test implemented immediately after the operation, resistance subsided considerably and eye movement was shown in all directions, with cosmetically satisfactory results. Optic atrophy was found in the fundus examination after the operation. CONCLUSIONS: Convergent strabismus fixus, which recurs frequently and causes severe limitation of eye movement, was changed from the primary position to orthophoria by medial rectus muscle resection with disinsertion and lateral rectus muscle tucking. The eye movement disorder was improved and a satisfactory result was obtained.
Cornea* ; Esotropia* ; Eye Movements ; Female ; Humans ; Middle Aged ; Ocular Motility Disorders ; Optic Atrophy ; Orbit