Anatomy and surgery of the levator aponeurosis in senile ptosis

The authors performed an anatomical and histological study on eight eyelids to define the lower insertions of the levator muscle. Twenty-nine cases of senile ptosis are presented in which levator aponeurosis surgery was successful. All patients were operated under local anesthesia. The authors used an aponeurotic repair when an aponeurosis dehiscence was identified during surgery (12 cases). The preoperative clinical appearance of all of these patients was typical and suggested the presence of a defect in the aponeurosis. In the 17 other cases the authors used aponeurosis tucking. This technique is easy and rapid and can be performed on very old patients. Histological anomalies of the aponeurosis were found out from biopsies. There is an anatomical analogy between the upper and the lower lid, and equally between senile ptosis and senile entropion, characterized by laxity or disinsertion of the lower lid retractor. One patient with a disinsertion of the aponeurosis and of the lower lid retractor is presented.     

Combined trabeculotomy-trabeculectomy as a first surgical procedure for primary congenital glaucoma

Early surgical results (mean follow-up=163 days) following combined trabeculotomy-trabeculectomy as a first surgical procedure for 20 consecutive cases in 14 children with primary congenital glaucoma were retrospectively examined. Mean pretreatment intraocular pressure was 25.55±9.58 mmHg, decreasing to 14.55±6.15 mmHg following treatment. Primary combined trabeculotomy-trabeculectomy was a useful initial procedure to control intraocular pressure in primary congenital glaucoma. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which include unlabeled, unapproved, or investigative products or devices.     

The acute effects of sildenafil on tear functions

The acute effects of 50 mg of sildenafil on tear functions were evaluated in 12 impotent patients. Mean tear breakup time, cotton thread, and Schirmer I tests were 19.42±6.45 s, 13.92±6.63 mm, and 16.58±12.19 mm, respectively before sildenafil and 20.33±10.40 s, 10.92±6.14 mm, and 18.08±12.36 mm, respectively, 1 hour after sildenafil. The results suggest that sildenafil does not adversely affect tear functions. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Site of Incision and Corneal Astigmatism in Conventional SICS versus Phacoemulsification

Introduction High astigmatism is an important cause of poor uncorrected visual acuity after cataract surgery. Purpose The aim of the study is to compare the astigmatism induced by a superior and temporal incision in manual SICS, and to compare the astigmatism induced by clear corneal incision versus scleral tunnel in phacoemulsification surgery. Methods A total of 64 eyes of 64 patients (34 male/30 female) with a mean age of 62.10 years (range 45–82 years) were included in the study. The cases were randomly divided into two groups. One group (Group I) had undergone manual SICS and the other group (Group II) had undergone phacoemulsification. The manual SICS group patients were randomly allotted into two subgroups depending on the site of incision. Group Ia received superior incision while group Ib received temporal incision. The Phacoemulsification group (Group II) patients were randomly divided into two groups depending on the location of the incision. Group IIa received clear corneal incision and group IIb received scleral pocket incision. Informed consent was obtained from all the patients undergoing study. Surgically induced astigmatism is calculated by the substraction method. Results and Conclusion We found significantly against the rule shift in stigmatism in the phacoemulsification group and the manual SICS superior incision group. The manual SICS group with temporal incision (Ib) had with-the-rule shift in astigmatism. Synopsis At 90 days, conventional SICS superior incisions gave 1.92 ± 0.53 D against the rule and temporal incisions 1.57 ± 0.24 D with the rule astigmatism. Phacoemulsification clear corneal incisions showed 1.08 ± 0.36 D and scleral pocket 1.23 ± 0.71 D astigmatism. Dr. Reddy is a Senior Resident, Dr. Raj is a Resident, and Dr. Singh is a Reader in the Department of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Estimating intraocular pressure using a glass rod

Four masked examiners studied the usefulness of the glass-rod for estimating intraocular pressure (IOP) in a living, anesthetized rabbit eye manometrically set to 135 different random values. With training, the average error in IOP estimation improved from 7.42±5.56 mmHg to 5.13±4.48 mmHg. Gentle palpation of the corneal apex with a glass-rod provides tactile and visual clues that may assist in estimating the IOP. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which include unlabeled, unapproved, or investigative products or devices.     

直肌联结术与改良部分直肌转位术治疗完全性麻痹性内斜视的疗效比较

目的:比较直肌联结术与改良部分直肌转位术治疗完全性麻痹性内斜视的疗效。方法:回顾分析我院2016-10/2020-10确诊完全性麻痹性内斜视患者35例44眼,其中15例21眼行直肌联结联合拮抗肌后徙术(联结组),20例23眼行改良部分直肌转位联合拮抗肌后徙术(转位组)。观察两组患者手术时长、手术前后原在位斜视度、外展麻痹程度、内直肌后退量及治愈率等。结果:两组患者一般资料及手术时长均无差异(P>0.05)。术后末次随访联结组患者斜视度由102.33±41.70PD降为3.93±4.82PD(P<0.001),外展麻痹由-4.81±0.40改善至-1.57±0.51(P<0.001);转位组患者斜视度由94.75±33.03PD降为2.85±5.96PD(P<0.001),外展麻痹由-4.91±0.29改善至-1.22±0.42(P<0.001)。术后两组间斜视度比较无差异(P>0.05),转位组较联结组外展麻痹改善佳(P<0.05)。联结组与转位组内直肌后退量分别为7.16±2.07和6.37±2.34mm(P>0.05)。术后末次随访：...     

不同下斜肌术式在V征治疗的临床观察

目的 对比观察下斜肌断腱术和下斜肌部分切除术在V征治疗中的效果.方法 取伴有下斜肌亢进的V征患者35例.使用三棱镜交替遮盖法测量视近时第一眼位及上下转25°时的水平斜视度.对下斜肌功能亢进程度进行分级.随机分为2组,分别行下斜肌断腱术和下斜肌部分切除术,观察术后3个月的上下转斜视度差值和下斜肌功能变化.结果 术后3个月时下斜肌断腱术组上下转斜视度差值平均为(5.6 4±5.4)△,下斜肌部分切除术组上下转斜视度差值平均为(4.7±4.3)△,两组相比无显著性差异(P>0.05).下斜肌断腱术组下斜肌功能+2级2只眼,+1级7只眼,0级21只眼.下斜肌部分切除术组下斜肌功能+2级1只眼,+1级5只眼,0级22只眼.两组相比无显著性差异(P>0.05).结论 下斜肌断腱术和下斜肌部分切除术都有效的解决了下斜肌亢进的V征问题,消除了垂直非共同性.     

Phacoemulsification with Viscodissection in Posterior Polar Cataract: Minimizing Risk of Posterior Capsule Tear

We retrospectively evaluated the efficacy of viscodissection in decreasing the risk of posterior capsule tear during phacoemulsification surgery in 23 eyes with posterior polar cataract. Eyes were randomly assigned to two groups prior to emulsification: cortical viscodissection (Group 1) or non-viscodissection (Group 2). The visual acuities similarly improved in all eyes in the two groups. Posterior capsule tear occurred in one eye in Group 1 and five eyes in Group 2 (p < 0.05). On the basis of these results, the viscodissection technique was safer and more efficient than the non-dissection technique. Drs. Taskapili, Gulkilik, Kocabora, and Ozsutcu are from the Vakif Gureba Education Hospital, Istanbul, Turkey. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices. The authors demonstrated that the viscodissection technique was safer and more efficient than the non-dissection technique during phacoemulsification surgery for posterior polar cataract.     

Surgical exploration in persistent inferior oblique overactions

Purpose

To report the causes of persistent inferior oblique (IO) overactions after disinsertion procedure.

Methods

Surgical findings of nine eyes of eight patients who needed secondary surgery to the IO muscles because of persistent overaction after IO disinsertion were evaluated retrospectively. Inferior obliques were found partially retracted into their sheath, and some parts of the proximal muscle stumps were found to have established attachments through scar tissues to the sclera in five eyes. They were totally in the subtenon space, reattached to the sclera in the three eyes and were found untouched; inferior rectus was disinserted instead of IO muscle, in the last eye. Proximal terminals of the IOs were isolated, dissected from its sheath and from other fascial attachments. The muscle stump pushed out of subtenon’s space through its Tenon’s sheath after 5–8 mm myectomy and cauterization to prevent any direct or indirect contact between the muscle and sclera.

Results

Persistent overactions of IO muscles were resolved in all cases and did not return in any case in the follow-up period of 4 months to 6 years.

Conclusions

Persistent overaction of IO muscle after disinsertion usually results from insufficient retraction of the muscle from the subtenon’s space. It can be both prevented and managed by complete dissection of the IO muscle from its all fascial attachments and pushing the proximal terminal of the muscle completely out of subtenon’s space through its sheath traversing Tenon’s capsule after a segment myectomy and cauterization.

     

The Incidence of After Cataract Following Three Different Types of Cataract Surgery in Children: A Meta-Analysis

Via meta-analysis, we assessed the effect of pediatric cataract surgery with posterior continuous curvilinear capsulorhexis (PCCC) with or without anterior vitrectomy (AV) on the incidence of after cataract. Group 1 consisted of pediatric cataract surgery with or without PCCC. Group 2 consisted of pediatric cataract surgery with PCCC with or without AV. The pooled odds ratio of after cataract in Group 1 was 0.21; in Group 2 it was 0.13. Pediatric cataract surgery with PCCC is superior to single cataract surgery in preventing the incidence of after cataract. Drs. Jian, Xiaolei, and Rongdi are from the Third Military Medical University, Department of Ophthalmology, Daping Hospital, Chongqing, China, 400042. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices. Using meta-analysis, the authors assessed the effect of pediatric cataract surgery with posterior continuous curvilinear capsulorhexis with or without anterior vitrectomy on the incidence of after cataract.     

Evaluation of Choroidal Thickness in Non-arteritic Anterior Ischaemic Optic Neuropathy at the Acute and Chronic Stages

The objective of this study was to evaluate the measurements of choroidal thickness (CT) in patients with non-arteritic anterior ischaemic optic neuropathy (NAION) at the acute and chronic stages. This case-control study compares three groups: Group 1 included 23 eyes of 23 patients with chronic NAION, Group 2 consisted of 24 eyes of 24 patients with acute NAION, and Group 3 included 24 eyes of 24 age-matched control subjects. The average CTs for Group 1, Group 2, and Group 3 were 261.24 ± 50.04, 280.05 ± 74.94, and 254.74 ± 50.11 µm, respectively. For all measurements, no statistical significance was found between the groups (p = 0.319, 0.357, 0.680, and 0.178 for the CTs as average, foveal, superior, and inferior, respectively). Similarly, there was no difference between the CT measurements of the affected and unaffected eyes in Group 1 and Group 2 (p = 0.571, 0.741 for average, respectively). The amount of time after the onset of the disease ranged from 6.0 to 48 months (23.86 ± 16.70 months) in Group 1 and from 1 to 30 days (7.45 ± 8.86 days) in Group 2. There was no correlation between the CTs and follow-up times in Group 1 (p = 0.768 for average) and no association between the CTs and the thicknesses of the retinal nerve fibre layers in Group 2 (p = 0.453 for average). CT is not directly influenced by NAION at either the acute or the chronic stage of the disease. These results may also demonstrate that the changes of CT do not increase the risk of experiencing a NAION attack.     

Original papers: Electrocautery paraplical incision for Faden operation

In case of Faden operation (Cüppers' operation) without recession of the muscle, the authors looked for a direct approach to the site where the posterior fixation sutures should be placed. They chose a paraplical incision. To prevent bleeding they used electrocautery following a surgical technique previously described. The authors performed electrocautery paraplical incision in 270 eyes of 238 patients (age ranged between 3 y and 55 y). Follow-up time was 2.4 y + 1.3. After electrocautery, preparation of the medial rectus muscle and Faden procedure (without disinsertion of the muscle) were carried out. Finally the conjunctiva was closed with single sutures. In no patient did long-term complications occur and only the following minor complications were observed intra- or perioperatively: in one patient orbital fat protruded during surgery. Postoperatively one eye had a corneal erosion and another severe eyelid edema. In another patient a swollen plica with consecutive putrid secretion was observed. In all three cases symptoms disappeared after therapy. Paraplical incision was even possible after previous strabismus surgery with limbal incision. In Faden operation without recession of the medial rectus muscle, electrocautery paraplical incision is an alternative method with minimal postoperative inflammation and minimal scarring. It allows good approach to the medial rectus muscle, with minimal intraoperative bleeding. Postoperative healing and cosmesis are good.     

Effects of topical metranidazole in ocular rosacea

Purpose To determine the indirect ocular effects of facially applied metranidazole in rosacea. Methods In this prospective study, 20 patients with ocular rosacea and 10 normal reference subjects were involved. Ten patients with ocular rosacea were treated with topical metranidazole for 8 weeks and the other 10 patients with ocular rosacea were observed as controls. Study parameters included impression cytology from upper-bulbar conjunctiva (UBC) and inferonasal-interpalpebral conjunctiva (IPC), tear break-up time (TBUT), Schirmer tests, and ocular symptoms and signs. Results Both UBC and IPC of ocular rosacea patients before treatment showed Grade 1 or greater advanced changes in comparison with the normal eyes. After 8 weeks of facial metranidazole application, improvements in ocular signs and symptoms were observed. TBUT increased to 10.1±2.8 seconds from 6.4±2.7 seconds (p<0.01). Schirmer test values of treated patients and of normal subjects were statistically comparable (p>0.05). Conclusion Facial application of topical metranidazole had an indirect treating effect on ocular rosacea. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes, unlabeled, unapproved, or investigative products or devices.     

The efficacy of superior rectus recession with simultaneous inferior oblique disinsertion on superior oblique palsy with superior rectus contracture

Purpose: The information about superior rectus (SR) recession in cases with SR contracture coexisting with superior oblique palsy (SOP) is very limited in previous literature. The aim of this study is to evaluate the effect of SR recession, as a combined procedure with inferior oblique (IO) disinsertion, in long-standing SOP with secondary SR contracture.

Methods: The medical records of the 145 patients operated for SOP were retrospectively reviewed and 15 patients who underwent SR recession met the inclusion criteria. The mean follow-up was 50.4 months.

Results: The preoperative angle of deviation was within the range of 16–35 prism dioptres (PD) with a mean of 23.0 ± 5.03 PD. In all of the cases, SR recession was performed in combination with IO disinsertion. Adult patients (12) underwent adjustable SR recession. Postoperative overcorrection developed in 3 cases (20%), and in 12 patients, the postoperative vertical deviation was within the range of 0–5 PD with a mean of 1.41 ± 1.88 PD. The overcorrected three patients underwent botulinum toxin A (BTXA) injection into the ipsilateral inferior rectus muscle. The deviation is well controlled by BTXA injection in two patients, whereas the other one was considered as masked bilateral SOP and underwent IO disinsertion in the other eye.

Conclusion: Our results suggested that SR recession in combination with IO disinsertion is an effective procedure to control large vertical deviations in SOP with SR contracture in the majority of cases. However, the risk of overcorrection should be considered despite adjustable SR weakening and BTXA injection seems efficient to rescue overcorrections in long term.     

Phacoemulsificatıon and Intraocular Lens Implantation in Eyes with Long Axial Length

We evaluated the results of phacoemulsification and intraocular lens implantation in 414 eyes with long axial length and classified them according to axial length (AL): Group A: AL: 25–28 mm, Group B: AL >28 mm. Intraoperative maneuvers, pre- and postoperative photocoagulation for predisposing retinal lesions and retinal detachment rates were significantly higher in Group B than Group A. Eyes with an axial length over 28 mm are prone to more problems when compared to those with an axial length between 25 and 28 mm. Dr. Ozbek is an Assistant Professor and Drs. Saatci, Durak, Gunenc, and Kaynak are Professors in the Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.The authors do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Vascular Endothelial Growth Factor Level in the Serum of Diabetic Patients with Retinopathy

We determined serum levels of vascular endothelial growth factor (VEGF) at different stages of diabetic retinopathy before laser photocoagulation in 65 patients (31 nonproliferative (Group 1) and 34 proliferative (Group 2)) and in healthy controls (Group 3). VEGF levels in all groups were different. There was a significant correlation between VEGF concentration and HbA1c levels. VEGF may be involved in the prediction of diabetic retinopathy and contributes to endothelial damage in diabetics. Drs. Celebiler Cavusoglu, Biglili, Doğan, Yilmaz, Aslanca, and Karaca are from the Ministry of Health, Izmir Education and Research Hospital Clinic Biochemistry, Izmar, Turkey. Drs. Alaluf, Yüksel, and Topaloglu are from the Ministry of Health, Izmir Education and Research Hospital, Ophthalmology Departmant, Izmar, Turkey. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices. The authors found a significant correlation between VEGF concentration and HbA1c levels and determined that VEGF may be involved in the prediction of diabetic retinopathy and contributes to endothelial damage in diabetics.     

A modified vertical muscle transposition for the treatment of large-angle esotropia due to sixth nerve palsy

Introduction: Multiple different procedures have been proposed to address complete sixth nerve palsy with severe abduction limitation. In this study, we report a modification of the Hummelsheim’s procedure. It is in fact muscle pulley transposition that obviates the need for tenotomy or muscle splitting. For the first time, Muraki and Nishida proposed this technique.

Materials and Methods: Patients with large angle esotropia and abduction limitation of minus four or greater were enrolled. The surgery involved insertion of a polyester monofilament fiber suture through the temporal muscular margin of each vertical rectus muscle at approximately one-third of the width from the edge at 10 mm behind the muscle insertion. We tried to insert sutures away from the vessels of vertical muscles. Then, the vertical muscles were transposed without any tenotomy or splitting and the sutures were secured to the sclera 16 mm from the limbus in supratemporal and infratemporal quadrants. In all of the patients, this transposition was combined with medial rectus recession.

Results: A total of 10 patients were included; all of them had an esotropia with profound abduction deficit (?4 or more). The mean age of patients was 44.2 ± 9.2 years (mean ± standard deviation) (range: 28–57). The mean preoperative deviation was 49.5 ± 9 PD prism diopters (PD) (range: 40–65 PD). The mean preoperative abduction limitation was ?4.8 ± 0.8. The patients were followed for at least 6 months. Postoperative deviation ranged from orthotropia to 12 PD of esotropia and all the patients obtained abduction at least beyond the midline. No vertical ductional disturbances or deviations were developed. The adduction was not compromised in any patient. Anterior segment ischemia did not occur in any patients.

Conclusion: This procedure is comparable to traditional procedures with the advantages of no need to tenotomy or splitting and can be a good alternative to conventional Hummelsheim’s procedure.     

Histology of a slipped muscle after strabismus surgery

A complication of strabismus surgery is a slipped muscle. We present a patient who suffered such a complication following surfical correction of strabismus. The resected part of the slipped muscle was histopathologically examined. Fibrovascular connective tissue was found in the specimen with no muscle fibers in it. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Autologous rectal mucosal grafts on the conjunctiva of healthy rabbits

We evaluated the feasibility and viability of 10×5 mm autologous rectal mucosal grafts on the superior bulbar conjuctival surface of 25 albino rabbits. After enucleation, histopathological studies revealed a mean goblet cell count of 190 cells per ×400 field and squamous cell metaplasia did not exceed 20%. Rectal mucosa transplantation into the conjuctiva of healthy rabbit’s eyes is possible. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Surgery for esotropia in myopic adults

We describe surgical treatment of four patients with late onset esotropia and significant myopia. Muscle recession and amount of resection was larger than is used in esotropic patients without myopia. Myopia that ranged from −4.0D to −7.75D, and esotropia measured 20 to 60 prism diopters. We suggest ordinary amounts of muscle recession or resection for patients with esotropia and myopia. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.