[Pay attention to abnormal vision screening for infants and young children].

World Heath Organization (WHO) put forward a global initiative to eliminate avoidable blindness by 2020. The avoidable blindness includes blindness in children such as amblyopia. The critical period of human visual development is from 0 to 3 years old when is just in the period of infancy and young childhood, therefore vision screening for infants and young children should be attached importance, which is critical significant to the children blindness prevention. Due to many aspects of causes, the vision and related risk factor screening for the infants and young children in China is still faced with many challenges. The article strengthened the aspects of the importance of vision screening for infants and young children and put forward some strategies and suggestions.

[The development and importance of molecular diagnosis in hereditary retinal diseases].

Hereditary retinal disease(HRD) is a group of retinal degenerations seen frequently at clinic,which can lead to severe visual impairments or even blindness.Identifying genetic causes and developing advanced and applicable molecular diagnostic tools for HRD is essential to lower the prevalence of HRD, and to find the therapeutic method of HRD. HRD is known to be both clinically and genetically heterogeneous. The large number of causative genes together with the limitation of routine technique hinder the investigators from further investigating the genetic causes of HRD. Targeted genes capture with next-generation high throughput sequencing yield high sensitivity and speed for mutation detection.When compared with traditional techniques, targeted sequencing presents tremendous advantages. Therefore, the development of a powerful molecular diagnostic platform for HRD aims to improve the detection rate of causative genes/mutations in HRD patients, to further investigate the genetic causes for HRD, to better understand the pathological basis of HRD, and to promote the fast development of molecular diagnosis in China. Meanwhile, it will have significance for the clinical and prenatal diagnosis of HRD, and thus providing rationale for gene therapy on HRD.

[Surgical treatment for correcting abnormal complicated head posture in nystagmus].

OBJECTIVE: To demonstrate the surgical choices for patients with complicated head posture associated with nystagmus. METHODS: It was a retrospective clinical study. Thirty-eight cases of congenital nystagmus with abnormal head posture in all three axes without strabismus were retrospectively analyzed. Twenty-nine(76.32%) cases whose dominant head posture were with face turn, 3 cases (7.89%) with chin up or down , respectively, were performed horizontal null zone shift as well as vertical null zone transposition; 2 cases (5.26%) with head tilt as the dominant position were underwent one tendon width transposition of all four vertical muscles;4 cases (10.53%)basically with the same degree for face turn and chip up or down, 2 cases were preferred with recess a group of horizontal yoke muscles and a group of vertical yoke muscles, the other 2 cases were combined with weaken both synergistic oblique muscles. SPSS 13.0 was used to analyse the difference of them. RESULTS: In 29 patients with horizontal head posture dominanted, 15 cases (68.18%) with 25 °-30 ° in horizontal head posture were corrected completely, 5°-15° was the residue for 7 cases (31.82%) with 35 °- 40 °degree in horizontal before surgery. 15 °-20° was residue for 3 cases larger than 40 ° before operation after modified Parks procedure. Anderson procedure can correct the angle of 15°-20° in 4 cases. The horizontal, vertical and torsional components of 22 cases whose predominant head posture were in horizontal with 25°-40° (3.18° ± 1.01°, 4.32° ± 1.14°, 4.55° ± 1.95°) were significantly reduced (t = 63.13, 3.57, 3.95;P < 0.01) after Parks procedure. Recession a group of vertical muscles 5mm or combined with oblique muscles in 3 patients could correct the 20° of vertical head posture, but the improvement of the other two axes was about 5°-10°.One tendon width transposition of all four vertical muscles in 2 cases could correct the 10° of head tilt and 10°-15°of chip up or down. Recession a group of horizontal and vertical muscles can correct 20°-25° of face turn and 20° of vertical head posture. CONCLUSIONS: When head turn with 25°-40°predominates over the vertical and torsional components, recess the horizontal muscles could be effective way in diminishing the abnormal head position on all three axes.When vertical or torsional head posture predominates for the complicated nystagmus, individual designs should be considered.When necessary, reoperations should be needed.

[Targeted sequencing identifies a hotspot mutation SNRNP200 p.S1087L correlates with novel phenotypes in retinitis pigmentosa].

OBJECTIVE: To identify the pathogenic mutation in a four-generation Chinese family with autosomal dominant retinitis pigmentosa (ADRP) and to analyze its associated clinical phenotypes. METHODS: Twelve participants from the index family were recruited, including 5 patients, 6 asymptomatic siblings, and one spouse. All participants underwent ophthalmic examinations, including best-corrected visual acuity (BCVA), visual field (VF) testing, fundus photography, and full-field flash electroretinography (ERG). Targeted sequence capture array technique with next-generation of high throughput sequencing(NGS) was performed to detect variants in 189 hereditary retinal disease (HRD) related genes, comprising 179 identified HRD-causing genes and 10 potential causative genes which were involved in pre-messenger RNA(pre-mRNA) splicing. Variants detected by targeted sequencing were filtered by bioinformatic analyses, validated by Sanger sequencing and intra-familiar analysis.Genotype-phenotype correlation was also analyzed. RESULTS: SNRNP200 p.S1087L was identified as the disease causative mutation for this family by targeted sequencing and optimized bioinformatic analyses. This family demonstrated early onset of the disease by presenting nyctalopia among 6 to 8 years old, performed rapid disease progression and severely impaired visual function by displaying loss of VF among 14 to 17 years old and decreased central vision among 21 to 28 years old. The fundus presentations and ERG results showed typical RP presentations. CONCLUSIONS: SNRNP200 p.S1087L is identified as a hotspot mutation but correlates with distinct phenotypes in the present family, including early onset of the disease, rapid disease progression, and severely impaired visual function. This study also give evidence to that molecular diagnostic platform for HRD can improve the detection rate of causative genes/mutations in HRD patients, thus providing important approaches for further investigation of the genetic causes for HRD.

[Study on the structure and function of inferior oblique connective tissue in different mammals].

OBJECTIVE: The purpose of this research lied in studying the structure and function of connective tissue of inferior oblique (IO) in rhesus, rabbit and rat. METHODS: It was an experimental study. Two adult monkeys (rhesus), five adult rabbits and five adult Wistar rats were involved in this study. The gross anatomy of an orbit in each animal was observed. Meanwhile, the fellow orbit was processed with paraffin imbedding and coronal serial section. Masson trichrome stain was used to distinguish muscle and collagen, and Weigert stain was performed for identification of elastin. RESULTS: The connective tissue around IO muscle in rhesus, rabbits and rats all connected with inferior rectus (IR) and lateral rectus (LR), but the arrangements among them were not entirely similar. Only the connective tissue around IO in rhesus consisted of dense collagen, scattered elastic fiber, and connected closely with IR, LR Pulley. The connective tissue circling IO in rabbit and rat were crumbly, and was not connected closely with the connective tissue around IR. CONCLUSION: IR and LR Pulley has some mechanics link with IO in rhesus, and can play roles in covergence in rhesus.

[Study on the structure and function of superior oblique connective tissue in different mammals].

OBJECTIVE: The purpose of this research lied in studying the structure and function of connective tissue of superior oblique (SO) in rhesus and rabbit. METHODS: It was an experimental study. Two adult monkeys (rhesus) and five adult rabbits were involved in this study. The gross anatomy of an orbit in each animal was observed. Meanwhile, the fellow orbit was processed with paraffin imbedding and coronal serial section. Masson trichrome stain was used to distinguish muscle and collagen, and Weigert stain was performed for identification of elastin. RESULTS: Connective tissue around SO in both mammals thickened anteriorly, reflected in the trochlea along with the SO tendon, and became contiguous with the nasal aspect of the SR connective tissue ring, while the tendon passed inferior to the SR pulley to insert on the sclera. CONCLUSION: The contraction of SO OL can cause SR shift nasally. This may explain the mechanism of vestibulo-ocular reflex (VOR) partly.

[Clinical treatment for perforating injuries with foreign bodies located at posterior global wall].

OBJECTIVE: To describe the clinical features and surgical outcomes in a series of patients with perforating injuries and foreign bodies located at the exit wound in posterior global wall. METHODS: Retrospective case series of 17 eyes of 17 patients were included in the study, each patient who received treatments between January 2006 and December 2010 had perforating injuries with foreign bodies located at posterior global wall. The exit wounds of perforating injuries were in the area of optic disc and macula in 8 eyes. Seventeen eyes had vitreous hemorrhage, 11 eyes had traumatic cataract, 8 eyes had retinal detachment and one eye had endophthalmitis. According to different therapeutic regimen, cases were divided into two groups. Group A (7 cases) underwent vitrectomy combined with extraction of foreign body as an emergency operation. Group B (10 cases) underwent extraction of foreign body as an emergency operation and secondary vitrectomy were performed 1 - 2 weeks later. The mean follow-up time was 18 months (ranged from 9 - 47 months). The functional and anatomical results were compared between Group A and B. Fisher's exact test were used to analyze the data. RESULTS: The foreign bodies were extracted in 17 cases. Poor final best corrected visual acuity (BCVA) (worse than or equal to 0.1) was presented in all 8 cases with the exit wound being in the area of optic disc and macula, but only in 4 of 9 cases with the exit wound located in other sites, the difference between these two groups was statistically significant (P = 0.029). At final follow-up, vision was improved in 5 cases from Group A and 7 cases from Group B (P = 1.000); BCVA were better than or equal to 0.1 in 4 cases from Group A and 3 cases from Group B (P = 0.350) the differences were statistically nonsignificant. Intraoperative leakage at the exit wound occurred in 4 cases from Group A and one from Group B, the difference was statistically significant (P = 0.015). Intraoperative retinal detachment and postoperative silicone oil leakage occurred in 2 cases from Group A and none from Group B (P = 0.154). Postoperative retinal detachment occurred in 1 case from Group A and 3 cases from Group B (P = 0.603). Silicone oil-dependent eye occurred in 1 case from Group A and 2 cases from Group B (P = 1.000); the differences were statistically nonsignificant. CONCLUSIONS: The visual prognosis is worse in cases with the exit wound being in the area of optic disc and macula. Both therapeutic regimens were effective, but each has their pros and cons. Appropriate therapeutic regimen should be selected in term of situations. To avoid leakage at the exit wound in vitrectomy, we recommend therapeutic regimen B be selected first.

[Gene mapping and analysis of candidate genes in a Chinese family with autosomal dominant congenital coralliform cataract].

OBJECTIVE: To map and to identify the causal gene of autosomal dominant congenital coralliform cataract (ADCC) in a Chinese family. METHODS: Case series study. Clinical features of all affected members in this family were examined. Blood samples were collected from nine family members for genetic linkage analysis. Polymorphic microsatellite markers were selected from the regions which harbor all known loci linked with ADCC. Direct genomic sequencing was used to evaluate the candidate gene. RESULTS: The affected members in this family showed classic phenotype of ADCC. The maximum two-point LOD score of 1.51 was obtained for marker D2S325 (θ = 0). The LOD score of 1.20 was obtained for marker D11S925. The CRYGC/CRYGD gene located on 2q33-q35 and the CRYAB gene located on 11q22-q22.3. Therefore, the CRYGC/CRYGD and CRYAB gene may be the candidate gene in this family. Sequencing of the coding regions of the CRYGD gene showed the presence of a heterozygous C→A transversion at nucleotide 70 in exon 2 of CRYGD that is associated with cataracts in this family. This mutation resulted in a proline to threonine substitution at amino acid 23 of the protein in the first of the four Greek key motifs that characterized this protein. No mutation in all exons of CRYGC and CRYAB gene were found in the family. CONCLUSION: Direct DNA sequence analysis revealed a C-to-A transition at nucleotide 70 of the CRYGD gene in this ADCC family.

[Recurrent N1173K mutation in FBN1 gene in a Chinese family with ectopia lentis].

OBJECTIVE: To study the disease-causing gene mutation in a Chinese family with ectopia lentis. METHODS: The phenotype of each family member in a Chinese family with ectopia lentis was identified by detailed clinical examination. The inheritance mode in this family was ascertained by the pedigree analysis. Linkage analysis was performed by microsatellite markers on chromosome 15 and LOD Score was calculated by Mlink program. Gene mutations were detected by sequence analysis to the whole coding region and exon-intron boundaries of the candidate gene. RESULTS: A significant LOD score of 3.01 was obtained at D15S978 on chromosome 15q21.1, where FBN1 gene was located. A C3519G change in exon 29 of FBN1 gene, resulting in asparagine change to lysine at codon 1173, was detected by direct sequence analysis. This mutation was absent in the normal family members and 100 normal controls. CONCLUSIONS: Our results indicate that c.C3519G (p.N1173K) mutation in FBN1 gene is the underlying molecular pathogenesis of this family with ectopia lentis.

[The variation characters of EPSC-IPSC in rat visual cortex II/III pyramidal neurons during critical period of visual development].

OBJECTIVE: To observe the characters of EPSC-IPSC induced by paired-pulse stimulation of rat visual cortex layer II/III pyramidal neurons during critical period of visual development, and discuss their relationships, to discuss the role of short-term synaptic plasticity in the critical period of visual development of rats. METHODS: Thirty Wistar rats were used, they were divided into P10-P12, P14-P16, P21-P23, P28-P30, P35-P37 five groups, n = 6. Whole-cell voltage clamp recording was performed, the membrane potential was clamped on -50 mV, 0 mV respectively to separate EPSC and IPSC. We set the PPR as the observation indicator, analyzed the developmental features of EPSC and IPSC induced by paired-pulse stimulation of different groups. RESULTS: The PPR of layer II/III pyramidal neurons in group P10-P12, P14-P16, P21-P23, P28-P30, P35-P37 was 0.43 ± 0.08, 0.07 ± 0.08, 0.10 ± 0.10, 0.20 ± 0.07, 0.22 ± 0.12 respectively. The PPR of group P14-P16 decreased, the difference was statistically significant compared with the group before eyes open (t = -3.13, P = 0.04). The PPR of corresponding groups was 0.6036 ± 0.3021, 0.2830 ± 0.0504, 0.0287 ± 0.0907, -0.0449 ± 0.1443, -0.3089 ± 0.05553 respectively (F = 5.0799, P = 0.0037), the PPR of IPSC gradually reduced with age, and turned negative from the P28-P30 group, changed from PPF to PPD. CONCLUSIONS: The PPR of EPSC response to visual stimuli rapidly, but did not change significantly in the critical period of visual development (P19-P32). The short-term depression of IPSC increased gradually from the eyes open to the end of the critical period of visual development, which may play a more important role in the process of layer II/III pyramidal neurons maturation and the critical period of visual development ending.

[R954 mutations in KIF21A gene in Chinese patients with congenital fibrosis of extraocular muscles].

OBJECTIVE: Screening KIF21A gene mutation in 9 families with congenital fibrosis of extraocular muscles and 7 sporadic cases. METHODS: Families were ascertained and patients underwent complete ophthalmological examinations. The probands of 9 families with CFEOM and 7 sporadic patients were recruited for this study after informed consent. Genomic DNA was isolated from 5 ml peripheral blood samples according to the standard methods. Direct sequencing was performed after PCR amplification to genomic DNA for detection of KIF21A gene mutation. RESULTS: We identified heterozygous KIF21A mutations in 14 of sixteen patients. Twelve of them harbor the most common mutation, c.2860C > T (p.R954W) and two of them harbor the second most common mutation, c2861G > A(p.R954Q). The R954 mutations account for 87.5% (14/16), in which 75% (12/16) are R954W, 12.5% (2/16) are R954Q. CONCLUSION: The R954 mutations are also hotspots in Chinese patients with CFEOM.

[Comparison between photographic analysis and orthopedic goniometer of measurement of compensatory head posture].

OBJECTIVE: To evaluate the application of relative reference point photographic analysis method and goniometer method for head posture measurement, and compare the characteristics of the two methods. METHODS: Thirty patients from March 2011 to April 2011 and August to September with AHP in our hospital were recruited. The AHP were measured by photographic analysis and goniometer method respectively. The data were analyzed by SPSS software. RESULTS: The mean AHP was 15.62° ± 7.48° by photographic analysis measurement, 15.50° ± 6.99° by goniometer measurement. The Pearson's correlation coefficient (r = 0.955, P < 0.001, t = 0.286, P = 0.777). CONCLUSIONS: Relative reference point photographic analysis is a simple and effective way to measure AHP. The results measured by the two methods are highly consistent.

[Recession of both horizontal rectus muscles in Duane Retraction Syndrome with significant globe retraction].

OBJECTIVE: To evaluate the effect of Recession of both horizontal rectus muscles in Duane Retraction Syndrome with significant globe retraction. METHODS: Sixteen cases with DRS were summarized retrospectively. All patients had undergone surgery with recession of both horizontal rectus muscles. All clinical records, including sex, age, types of DRS, clinical features, surgical methods and clinical outcomes were analyzed. All patients were followed up for 3 months to 1 year. RESULTS: Fifteen cases had only monocular involvement while one had both eyes. The number of type I DRS was 3 cases, 1 case was esotropia while others were orthotropic in primary position. Type III DRS was observed 13 cases. Esotropia was seen in 6 cases (7 eyes), exotropia of 1 cases and orthotropic in primary position of 6 cases. 10 cases exhibited marked face turn. An upshoot or downshoot and variable severity of retraction of globe were found in all patients on attempt adduction of the affected eye. All patients had undergone surgery with recession of both horizontal rectus muscles. The medical rectus muscles were recessed from 5 mm to 7 mm and lateral rectus muscles 3 mm to 9 mm simultaneously, which was based on the amount of primary position deviation. Among these 2 cases were combined with Y-splitting of lateral rectus muscle. After surgery, all patients were orthotropic in primary position. Their symptom of unacceptable abnormal head position, significant globe retraction, noticeable narrowing of the palpebral fissure and significant upshoot or downshoot were ameliorated or disappeared. Especially the recession of lateral rectus muscle in addition to Y-splitting combining with the simultaneous medial rectus recession resulted in further amelioration of globe retraction in addition to upshoot and downshoot. CONCLUSION: Recession of both horizontal rectus muscles is effective in the treatment of significant globe retraction in Duane syndrome. Type III DRS with significant globe retraction but has no marked deviation and face turn can adopt this method to ameliorate their aspect. The method of lateral rectus muscle in addition to Y-splitting plays an important role in the treatment of upshoot and downshoot.

[Effects of bone marrow mesenchymal stem cell transplantation on retinal cell apoptosis in premature rats with retinopathy].

OBJECTIVE: To explore the effects of marrow mesenchymal stem cell (BMSC) transplantation on retinal cells apoptosis and changes to neurotrophin-3 (NT-3 and ciliary neurotrophic factor (CNTF) in rats with retinopathy of prematurity (ROP). METHODS: Seven-day-old Sprague-Dawley rats were randomly divided into normal control (CON), ROP, BMSC transplantation (BMSCs were transplanted 5 days after oxygen conditioning) and phosphate buffered saline (PBS) groups. The ROP model was prepared according to the classic hyperoxygen method. Seven days after transplantation, TUNEL/DAPI, NT-3/API and CNTF/DAPI double-labeled immunofluorescence were used to examine the effects of BMSC transplantation on both the apoptosis of retinal cells and the expression of NT-3 and CNTF protein in the retinal cells of the ROP rats. RESULTS: Seven days after BMSC transplantation, there were few TUNEL+ DAPI+ cells observed in the CON group. There were fewer TUNEL+DAPI+ cells observed in the BMSC group than in the ROP group (P<0.01), but there was no significant difference between the ROP and PBS groups (P>0.05). There were few NT-3+DAPI+ cells and CNTF+DAPI+ cells in the CON group. There were more NT-3+DAPI+ and CNTF+DAPI+ cells in the ROP group than in the CON group, but there was no significant difference between the ROP and CON groups (P>0.05). More NT-3+DAPI+ and CNTF+DAPI+ cells were observed in the BMSC group compared with the ROP group (P<0.01), and there was no significant difference in either NT-3+DAPI+ or CNTF+DAPI+ cells between the ROP and PBS groups (P>0.05). CONCLUSIONS: BMSC transplantation therapy could alleviate the apoptosis of retinal cells in ROP rats, and its mechanisms might be associated with promoting the expression of NT-3 and CNTF protein in retinal cells.

[Exploration of using microscope in strabismus surgery in China].

The opening of time of microsurgery by introduction of operation microscope into ophthalmic surgery rendered the coming of a new era of modern cataract surgery and vitreous surgery. However, after this time goes through half a century, telescopic loupes are still been advocated by most surgeons internationally. Is microsurgery a patent only for use in intraocular operations? Although an earliest exploration of using microscope in strabismus surgery in China was reported in the 90 s that discussed the technique of rectus ciliary vessel separation under microscope, no more followed after that. Since this century, some experts often as intraocular surgeons and some young doctors with background of microscopic training continued persistence in the exploration of microscopic strabismus surgery. During this process, the council of strabismus and pediatric ophthalmology of COS has been engaged in guiding its healthy development, unearthing its value in strabismus surgery and pursuing the raise of operation quality. This issue was hotly communicated and discussed at the 14 th national meeting of strabismus and pediatric ophthalmology held in Jinan in June, 2011. This article summarized the goal and the importance of microscopic strabismus surgery and suggested the measures for the healthy development of microscopic strabismus surgery according to the current status.

[Molecular genetics advances of congenital idiopathic nystagmus].

Congenital idiopathic nystagmus (CIN) is genetically heterogeneous. Autosomal dominant, autosomal recessive and X-linked patterns of inheritance have described. At least three distinct loci are related to autosomal dominant and X-linked patterns. One causative gene for X-linked form has been identified (FRMD7, Xq26.2) through linkage analysis. The molecular genetics advances of the congenital idiopathic nystagmus (CIN) are reviewed.

[The progress of intermittent exotropia].

Intermittent exotropia is a type of strabismus between exophoria and constant exotropia. The onset age is usually one to four years old. Different from other types of strabismus, intermittent exotropia patient can maintain normal binocular vision in a long period of time. So how to choose the optimal timing and effective treatment is a challenge for clinicians. The objective of this article is to review the recent research progress of intermittent exotropia, including the severity classification, non-surgical treatment, timing of surgery and surgical methods, overcorrection and under correction treatment etc., and give some recommendations for the treatment of intermittent exotropia.

[A pilot study on characteristics of microsaccadic eye-movements in anisometropic amblyopia].

OBJECTIVE: To quantitatively investigate the characteristics of the microsaccadic eye-movements in anisometropic amblyopia and to evaluate the using value of high-speed eye-movement recording in objective and quantitative evaluation and diagnosis of amblyopia. METHODS: From September in 2010 to March in 2011, 19 cases of anisometropic amblyopic patients (19 amblyopic eyes as group AM and 19 their sound eyes as group AS) and 19 cases of subjects with normal corrected visual acuities (19 dominant eyes as group ND and 19 non-dominant eyes as group NN) were recruited from the outpatient clinic at Tianjin Eye Hospital. A high-speed eye-movement recording system was used to monocularly record the fixational eye-movements of subjects' both eyes. A Matlab routine was used to detect and analyze the microsaccadic components of eye-movement waveforms. The microsaccadic amplitudes, peak velocities, occurrence rates, inter-microsaccadic intervals, cumulative probabilities of all groups were analyzed and compared using Origin8.0 and Matlab2008 statistics toolbox. RESULTS: The mean microsaccadic amplitude of group AM (0.76 ± 0.07)° was larger than groups AS, ND and NN (F = 49.95, P = 0.000). The mean peak velocity of group AM (79.72 ± 5.64)°/s was faster than groups AS, ND and NN (F = 4.93, P = 0.004). The mean occurrence rate of group AM (1.52 ± 0.08) Hz was less than groups AS, ND and NN (F = 120.39, P = 0.000). The mean inter-microsaccadic interval of group AM (537.40 ± 65.47) ms was longer than groups AS, ND and NN (F = 4.41, P = 0.007). The amplitude dependent cumulative probability curve of group AM shifted to right compared with other groups and its amplitude 0.67° ± 0.06° at half cumulative probability was obviously increased compared with other groups (F = 203.05, P = 0.000). CONCLUSION: Microsaccadic amplitude, peak velocity, occurrence rate, inter-microsaccadic interval and cumulative probability could be used as the parameters for objective and quantitative evaluation of eye-movement function in amblyopia. High-speed eye-movement recording could provide useful assistance in evaluation of eye-movements in amblyopic patients.

[Surgical treatment of myopic strabismus fixus by modified Yokoyama's surgery].

OBJECTIVE: To evaluate the surgical results of modified Yokoyama's procedure for treating myopic strabismus fixus. METHODS: Retrospective analysis of records of 5 patients (7 eyes) with high myopic strabismus. Pre- and postoperative orthoptic measurements were recorded and analyzed. Anatomic relationships between the muscle cone and globe were analyzed using MRI or CT scan. The surgical procedure is a modification of Yokoyama's technique and medial rectus muscle was also recessed. RESULTS: The average axis length of 7 eyes was 32.62 mm (SD1.84). The mean preoperative horizontal deviation was 82.86 PD (SD 37.62) esotropia and mean vertical deviation was 20 PD (SD 7.91) hypotropia. All patients had marked limitation of elevation and abduction. Displacement of the lateral rectus inferiorly and superior rectus medially was demonstrated in each patient by CT or MRI scan of the orbits and by observation during surgery. After surgery, the supertemporal dislocation of globe was improved. Both the horizontal and vertical deviations decreased significantly, and the abduction and sursumduction motility were also improved gradually. The average follow-up was 5 months, all patients achieved satisfactory results and remained stable. CONCLUSIONS: In high myopic patients, if the deviant paths of the LR and SR muscles were demonstrated by MRI or CT scan, the surgical procedure to restore the dislocated globe back into the muscle cone by uniting muscle bellies of the superior rectus and lateral rectus muscles is effective and recommended.

[Vertical retraction syndrome caused by anomalous orbital structures].

OBJECTIVE: To described the clinical feature and MRI imaging of six children with vertical retraction syndrome. METHODS: Six children with unilateral vertical retraction syndrome between 15 months and 8 years of age, mean age was (5.01 ± 1.27) years old. Strabismus examination included diopter, prism diopters, eye movement examination, binocular vision and fundus examination. Imaging of the ocular motor nerves at the brainstem was performed in 0.8 mm thickness image planes using 3D-FIESTA sequence, the orbits were imaged with FSE T1, T2WI using surface coils, and within 2.0 mm thick planes. RESULTS: Four children showed hypertropia, characterized by limited depression, a light retraction of the globe during downward gaze and eyelid lag. The MRI imaging showed anomalous orbital structure in the superonasal quadrant that between medial rectus and superior rectus or adjacent to the superior rectus. Two children showed intermittent exotropia, characterized by limited elevation, retraction of the globe and narrowing of the palpebral fissure during upward gaze. The MRI imaging showed anomalous orbital structure was present in the inferotemporal quadrant, one originate in inferior rectus and another close to the lateral rectus. CONCLUSION: Anomalous orbital structures are a main cause of vertical retraction syndrome. The presence of specific unusual eye movement and MRI imaging may assist in diagnosis. When the eyelid lag was found since the early age, anomalous orbital structures were implied.