ABSTRACT
Purpose@#To report a case of preseptal cellulitis after strabismus surgery in a patient with no previous history of ocular surgery.Case summary: A 33-year-old male visited the ophthalmology clinic with a 4-day history of left eye pain and lid swelling after strabismus surgery. He was a healthy patient with a history of polio resulting in left hemiparalysis and difficulty walking. He was followed up with left medial rectus and lateral rectus muscle resection surgery for secondary sensory esotropia. His best corrected visual acuity was 0.6 in his left eye and physical examination revealed pain, eyelid edema, chemosis, and purulent discharge from the left conjunctival fornix. Computed tomography scanning with contrast enhancement revealed diffuse preseptal periorbital soft tissue swelling and enhanced fat stranding suggesting left preseptal cellulitis. The patient was hospitalized with intravenous broad spectrum antibiotics. Left eye swelling was improved and purulent discharge had decreased after 3 days; he was discharged after a 5-day course of intravenous antibiotic treatment. Oral antibiotics were administrated for 1 week. The patient had no recurrent symptoms during the 3-month follow-up. @*Conclusions@#Although rare, preseptal cellulitis after strabismus surgery must be promptly recognized to prevent secondary complications related to infection.
ABSTRACT
Purpose@#Silicone tube intubation is the most common method for treatment of nasolacrimal drainage disorder or repair of lacerated canaliculus. However, some cases are prolapsed earlier than expected, subsequently affecting the success rate of silicone tube intubation. The author introduced a successful reposition of the prolapsed silicone tube. @*Methods@#This study is a retrospective case series of 11 patients who were treated with reposition of prolapsed silicone tube using hole and lacrimal probe method. In all cases, the tubes were prolapsed within 2 months after the first surgery due to careless rubbing of the medial canthus by the patient. In all 11 cases, the development of a biofilm on tube was not observed at the time when the tube was prolapsed. All patients underwent immediate reposition of prolapsed tube without local anesthesia in the outpatient operating room on the day they visited. @*Results@#In all 11 cases, the prolapsed silicone tube was repositioned without any complications using this hole and lacrimal probe method. At 6-month follow-up examination, all patients presented with a well-positioned silicone tube up to the day of extubation without replacing it with a new silicone tube. @*Conclusions@#This hole and lacrimal probe method is effective for the repositioning of prolapsed silicone tube after bicanalicular intubation of lacrimal system. This procedure includes easy performance in a short time and without local anesthesia in the outpatient operating room.
ABSTRACT
Purpose@#To report a case of preseptal cellulitis after strabismus surgery in a patient with no previous history of ocular surgery.Case summary: A 33-year-old male visited the ophthalmology clinic with a 4-day history of left eye pain and lid swelling after strabismus surgery. He was a healthy patient with a history of polio resulting in left hemiparalysis and difficulty walking. He was followed up with left medial rectus and lateral rectus muscle resection surgery for secondary sensory esotropia. His best corrected visual acuity was 0.6 in his left eye and physical examination revealed pain, eyelid edema, chemosis, and purulent discharge from the left conjunctival fornix. Computed tomography scanning with contrast enhancement revealed diffuse preseptal periorbital soft tissue swelling and enhanced fat stranding suggesting left preseptal cellulitis. The patient was hospitalized with intravenous broad spectrum antibiotics. Left eye swelling was improved and purulent discharge had decreased after 3 days; he was discharged after a 5-day course of intravenous antibiotic treatment. Oral antibiotics were administrated for 1 week. The patient had no recurrent symptoms during the 3-month follow-up. @*Conclusions@#Although rare, preseptal cellulitis after strabismus surgery must be promptly recognized to prevent secondary complications related to infection.
ABSTRACT
Purpose@#Silicone tube intubation is the most common method for treatment of nasolacrimal drainage disorder or repair of lacerated canaliculus. However, some cases are prolapsed earlier than expected, subsequently affecting the success rate of silicone tube intubation. The author introduced a successful reposition of the prolapsed silicone tube. @*Methods@#This study is a retrospective case series of 11 patients who were treated with reposition of prolapsed silicone tube using hole and lacrimal probe method. In all cases, the tubes were prolapsed within 2 months after the first surgery due to careless rubbing of the medial canthus by the patient. In all 11 cases, the development of a biofilm on tube was not observed at the time when the tube was prolapsed. All patients underwent immediate reposition of prolapsed tube without local anesthesia in the outpatient operating room on the day they visited. @*Results@#In all 11 cases, the prolapsed silicone tube was repositioned without any complications using this hole and lacrimal probe method. At 6-month follow-up examination, all patients presented with a well-positioned silicone tube up to the day of extubation without replacing it with a new silicone tube. @*Conclusions@#This hole and lacrimal probe method is effective for the repositioning of prolapsed silicone tube after bicanalicular intubation of lacrimal system. This procedure includes easy performance in a short time and without local anesthesia in the outpatient operating room.
ABSTRACT
Background@#Electrical socket outlets are used continuously until a failure occurs because they have no indication of manufacturing date or exchange specifications. For this reason, 659 electrical fires related to electrical socket outlets broke out in the Republic of Korea at 2018 only, an increase year on year. To reduce electrical fires from electrical socket outlets, it is necessary to perform an accelerated test and analyze the thermal, insulation resistance, and material properties of electrical socket outlets by installation years. @*Methods@#Thermal characteristics were investigated by measured the temperature increase of electrical socket outlets classified according to year with variation of the current level. Insulation resistance characteristics was measured according to temperature for an electrical socket outlets by their years of use. Finally, to investigate the thermal and insulation resistance characteristics in relation to outlet aging, this study analyzed electrical socket outlets’ conductor surface and content, insulator weight, and thermal deformation temperature. @*Results@#Analysis showed, regarding the thermal characteristics, that electrical socket outlet temperature rose when the current value increased. Moreover, the longer the time that had elapsed since an accelerated test and installation, the higher the electrical socket outlet temperature was. With respect to the insulation resistance properties, the accelerated test (30 years) showed that insulation resistance decreased from 110 °C. In relation to the installation year (30 years), insulation resistance decreased from 70 °C, which is as much as 40 °C lower than the result found by the accelerated test. Regarding the material properties, the longer the elapsed time since installation, the rougher the surface of conductor contact point was, and cracks increased. @*Conclusion@#The 30-year-old electrical socket outlet exceeded the allowable temperature which is 65 °C of the electrical contacts at 10 A, and the insulation resistance began to decrease at 70 °C. It is necessary to manage electrical socket outlets that have been installed for a long time.
ABSTRACT
Background@#Electrical socket outlets are used continuously until a failure occurs because they have no indication of manufacturing date or exchange specifications. For this reason, 659 electrical fires related to electrical socket outlets broke out in the Republic of Korea at 2018 only, an increase year on year. To reduce electrical fires from electrical socket outlets, it is necessary to perform an accelerated test and analyze the thermal, insulation resistance, and material properties of electrical socket outlets by installation years. @*Methods@#Thermal characteristics were investigated by measured the temperature increase of electrical socket outlets classified according to year with variation of the current level. Insulation resistance characteristics was measured according to temperature for an electrical socket outlets by their years of use. Finally, to investigate the thermal and insulation resistance characteristics in relation to outlet aging, this study analyzed electrical socket outlets’ conductor surface and content, insulator weight, and thermal deformation temperature. @*Results@#Analysis showed, regarding the thermal characteristics, that electrical socket outlet temperature rose when the current value increased. Moreover, the longer the time that had elapsed since an accelerated test and installation, the higher the electrical socket outlet temperature was. With respect to the insulation resistance properties, the accelerated test (30 years) showed that insulation resistance decreased from 110 °C. In relation to the installation year (30 years), insulation resistance decreased from 70 °C, which is as much as 40 °C lower than the result found by the accelerated test. Regarding the material properties, the longer the elapsed time since installation, the rougher the surface of conductor contact point was, and cracks increased. @*Conclusion@#The 30-year-old electrical socket outlet exceeded the allowable temperature which is 65 °C of the electrical contacts at 10 A, and the insulation resistance began to decrease at 70 °C. It is necessary to manage electrical socket outlets that have been installed for a long time.
ABSTRACT
OBJECTIVE: This is prospective study of clinical outcomes of percutaneous plasma disc coagulation Therapy (PDCT) in patients with herniated lumbar disc disease (HLD) to evaluate the safety and efficacy in its clinical application and usefulness as a reliable alternative to microscopic discectomy. METHODS: Forty-six patients were enrolled in this study from April 2006 to June 2010. All patients had one-level HLD. Disc degeneration was graded on routine T2-weighted magnetic resonance Image (MRI) using the Pfirrmann's grading system and all index levels were grade 3 and grade 4. Indications for surgery were radiculopathy caused by disc protrusion with soft consistency. MRI was done at one month after the procedure in all patients to check post-PDCT change. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. RESULTS: This study was approved by the Institutional Review Board of our institution. The age of the study population ranged from 16 to 59 years with a mean age of 37.2 years. There were 29 males and 17 females in this study. The mean period of clinical follow-up was 21 months. The average preoperative VAS score for radiculopathy was 7.4+/-1.4, while the final follow-up VAS score was 1.4+/-0.7 (p<0.001). In MacNab's criteria, 41 patients (89.1%) had achieved favorable improvement (excellent and good) until later follow-up. There were one patient from infection and two patients who needed to convert to open discectomy. CONCLUSION: PDCT is a safe and efficient treatment modality in a selective patient with HLD.
Subject(s)
Female , Humans , Male , Ethics Committees, Research , Follow-Up Studies , Intervertebral Disc Degeneration , Intervertebral Disc Displacement , Magnetic Resonance Spectroscopy , Plasma , Prospective Studies , Radiculopathy , Weights and MeasuresABSTRACT
Injury of common iliac vein related to lumbar discectomy is a rare complication. We report a patient who sustained injury of common iliac vein during lumbar discectomy for extraforaminal lumbar herniated disc. In this case, she had hypovolemic shock due to massive bleeding, and underwent emergent interventional treatment and open laparatomy. Although the vascular injuries were successfully repaired, it could be a fatal complication. We report the clinical features and early management, emphasizing the need for rapid diagnosis, immediate intervention and treatment for favorable outcome.
Subject(s)
Humans , Diskectomy , Glycosaminoglycans , Hemorrhage , Iliac Vein , Intervertebral Disc Displacement , Shock , Vascular System InjuriesABSTRACT
OBJECTIVE: This is retrospective study of clinical and radiological outcomes of anterior cervical fusion using Bongros-HA(TM) (BioAlpha, Seongnam, Korea) which is a type of synthetic hydroxyapatite (HA) spacer to evaluate the efficacy in its clinical application and usefulness as a reliable alternative to autograft bone. METHODS: Twenty-nine patients were enrolled in this study and 40 segments were involved. All patients were performed anterior cervical interbody fusion using HA spacer and plating system. Indications for surgery were radiculopathy caused by soft-disc herniation or spondylosis in 18 patients, spondylotic myelopathy in 1 patient, and spinal trauma in 10 patients. Cervical spine radiographs were obtained on postoperative 1day, 1week, and then at 1, 2, 6, and 12 months in all patients to evaluate intervertebral disc height, and the degrees of lordosis. Cervical computed tomography was done at postoperative 12 month in all patients to confirm the fusion status. The mean period of clinical follow-up was 17 months. RESULTS: Complete interbody fusion was achieved in 100% of patients. Preoperative kyphotic deformities were corrected in all cases after surgery. Intervertebral disc height was well maintained during follow up period. There were no cases of graft extrusion, graft deterioration and graft fracture. CONCLUSION: HA spacer is very efficient in achieving cervical fusion, maintaining intervertebral disc height, and restoring lordosis. When combined with the placement of a cervical plate, immediate stability can be achieved and graft related complication can be prevented.
Subject(s)
Animals , Humans , Congenital Abnormalities , Durapatite , Follow-Up Studies , Intervertebral Disc , Lordosis , Radiculopathy , Retrospective Studies , Spinal Cord Diseases , Spine , Spondylosis , TransplantsABSTRACT
PURPOSE: Fine needle aspiration cytology (FNAC) has become a standard diagnostic tool for thyroid nodules. The purpose of this study is to analyze the correlation between FNAC and the final histology to improve the diagnostic value. METHODS: We collected 792 patients who had undergone thyroidectomy, and we selected 549 patients who had undergone preoperative FNAC. The FNAC results were classified as non-diagnostic, malignancy, indeterminate and benign. The final pathologic reports were classified into two categories: malignant or benign. The individual histology was also identified. We retrospectively analyzed the pathologic result, the sensitivity, the specificity and the predictive value of the FNAC. RESULTS: Among 549 patients, their FNACs showed 47 non diagnostic results, 189 malignancies,136 indeterminate results and 177 benign results. The false positive rate was 1.1% and the false negative rate was 12.9%. The final pathology reports were 262 malignancies and 287 benign lesions. There were 42 (30.9%) malignancies among the 136 indeterminate cases. Adenomatous hyperplasia was the most common benign lesion and papillary carcinoma (containing micropapillary carcinoma) was the most common benign lesion. CONCLUSION: FNAC is an easy and safe diagnostic tool, but it still has many limitations. It is necessary to reduce the number of non diagnostic results. Technical advances, classification of the advanced categories of cytology and other staining methods can provide more specific results, and this can reduce the rate of performing unnecessary surgery.
Subject(s)
Humans , Biopsy, Fine-Needle , Carcinoma, Papillary , Classification , Hyperplasia , Pathology , Retrospective Studies , Sensitivity and Specificity , Thyroid Nodule , Thyroidectomy , Unnecessary ProceduresABSTRACT
Oculomotor nerve palsy (ONP) with subarachnoid hemorrhage (SAH) occurs usually when oculomotor nerve is compressed by growing or budding of posterior communicating artery (PcoA) aneurysm. Midbrain injury, increased intracranial pressure (ICP), or uncal herniation may also cause it. We report herein a rare case of ONP associated with SAH which was caused by middle cerebral artery (MCA) bifurcation aneurysm rupture. A 58-year-old woman with clear consciousness suffered from headache and sudden onset of unilateral ONP. Computed tomography showed SAH caused by the rupture of MCA aneurysm. The unilateral ONP was not associated with midbrain injury, increased ICP, or uncal herniation. The patient was treated with coil embolization, and the signs of oculomotor nerve palsy completely resolved after a few days. We suggest that bloody jet flow from the rupture of distant aneurysm other than PcoA aneurysm may also be considered as a cause of sudden unilateral ONP in patients with SAH.
Subject(s)
Female , Humans , Middle Aged , Aneurysm , Arteries , Consciousness , Headache , Intracranial Aneurysm , Intracranial Pressure , Mesencephalon , Middle Cerebral Artery , Oculomotor Nerve , Oculomotor Nerve Diseases , Rupture , Subarachnoid HemorrhageABSTRACT
Capsule endoscopy (CE) provides a minimally invasive examination of the entire small intestine, and is the preferred procedure for evaluation of patients with GI bleeding of unknown origin. Even though the FDA approved its use for pediatric patients between 10 and 18 years old in January 2004, little information is available regarding the effectiveness of CE in the younger pediatric population (below 6 years old) because of safety issues. A 42-month child with recurrent melena was referred to evaluate the cause of gastrointestinal bleeding. Despite extensive evaluation, including EGD, colonoscopy, a small bowel series, and Meckel's scan, the bleeding source was not identified. Finally, wireless CE demonstrated angiodysplasia on the mucosa of proximal jejunum. This is the first pediatric case of endoscopy-assisted CE under intravenous sedation without endotracheal intubation in Korea.
Subject(s)
Child , Humans , Angiodysplasia , Capsule Endoscopy , Colonoscopy , Hemorrhage , Intestine, Small , Intubation, Intratracheal , Jejunum , Korea , Melena , Mucous Membrane , Child, PreschoolABSTRACT
The main characteristics of molecular structures of the yeast Saccharomyces cerevisiae cell wall are now elucidated. The cell wall of Saccharomyces cerevisiae is composed of inner layer and outer layer and is the structure that plays an important role of providing physical and chemical protection and deciding the morphology of the cell. The inner layer of the cell wall is responsible for the mechanical strength of the wall and also providing the attachment sites for the proteins that form the outer layer of the cell wall. The outer protein layer limits the permeability of the cell wall, therefore, shields the plasma membrane from perturbation stimuli by foreign material such as enzymes and other chemicals. The molecular composition and organization of the cell wall may vary according to the environmental circumstances. The formation and genetic control of the specific cell wall protein-polysaccharide complexes is influenced by external conditions and stimuli. Cell wall construction is tightly controlled and strictly coordinated with progression of the cell cycle. This is reflected in the usage of specific cell wall proteins during consecutive phases of the cell cycle and in the recent discovery of a cell wall integrity checkpoint.
Subject(s)
Cell Cycle , Cell Membrane , Cell Wall , Molecular Structure , Permeability , Saccharomyces cerevisiae , Saccharomyces , YeastsABSTRACT
Dental caries is the most common disease in the oral cavity. However, the mechanism and treatment of dental caries is not completely understood since many complex factors are involved. Especially the effect of pH on remineralization of early stage of dental caries is still controversial. In this study, dental caries in dentin was induced by using lactic acidulated buffering solutions and the loss of inorganic substance was measured. Also decalcified specimens were remineralized by three groups of solution with different pH (group of pH 4.3, 5.0, and 5.5). Then, the amount and the area of inorganic substance precipitation was quantitatively analyzed with microradiograph. Also a qualitative comparison of the normal phase, the demineralized phase, and the remineralized phase of hydroxyapatite crystal was made under SEM. The results were as follows; 1. In microradiograghic analysis, as the pH increased, the amount of remineralization in decalcified dentin tended to increase significantly. As the pH decreaced, deeper decalcification, however, occurred along with remineralization. The group of pH 5.5 had a tendency to be remineralized without demineralization (p < 0.05). 2. In SEM view, the remineralization in dentine caries occurred from the hydroxyapatite crystal surface surrounding the mesh of organic matrix, and eventually filled up the demineralized area. 3. 5 days after remineralization, hydroxyapatite crystal grew bigger with deposition of inorganic substance in pH 4.3 and 5.0 group, and the crystal in the remineralized area appeared to return to normal. After 10 days, the crystals in group of pH 4.3 and 5.0, which grew bigger after 5 days of remineralization, turned back to their normal size, but in group of pH 5.5, some crystals were found to double their size. In according to the results of this experiment, the decalcifying and remineralizing process of dentine is neither simple nor independent, but a dynamic process in which decalcification and remineralization occur simultaneously. The remineralization process occurred from the hydroxyapatite crystal surface.
Subject(s)
Dental Caries , Dental Enamel , Dentin , Durapatite , Hydrogen-Ion Concentration , MouthABSTRACT
OBJECTIVES: Using two stimuli, this study was designed to evaluate variations of P300 in relations to reaction time of pressing the button for target tones in patients with schizophrenia. METHODS: The auditory oddball paradigm was used for the patients (N=22) and normal controls (N=23). The two stimuli were composed of target (20%, 2000 Hz, 75 dB) tone and standard (80%, 1000 Hz, 75 dB) tone, with 2 sec inter-stimulus interval, 50 msec duration and 10 msec rise or fall time. In each subject, P300s were acquired for both fast reaction time (FRT) and slow reaction time (SRT) to target response. RESULTS: P300 amplitude in patients with schizophrenia was lower than controls across FRT and SRT (p0.8). In this study, even though the reaction time for the button pressing task might be faster in patients with schizophrenia (p<0.1), the P300 to FRT in patients with schizophrenia was lower than the P300 to SRT in controls (p<0.01). CONCLUSION: These results suggest that the lower P300 in patients with schizophrenia might be due to cognitive dysfunction and the patient's performance in reaction time for pressing buttons, both independently. Thus, P300 as well as reaction time may be used to further explore a variety of domains of cognitive function.
Subject(s)
Humans , Evoked Potentials , Reaction Time , SchizophreniaABSTRACT
PURPOSE: Laser epithelial keratomileusis (LASEK) is a refractive surgery technique in which the cornea is covered with the epithelial flap after keratectomy. However, there have been reports of tissue damage by the alcohol utilized in this procedure while preparing the epithelial flap, which has led to novel methods. One of these is the mechanical designing of the epithelial flap named epipolis laser assisted in situ keratomileusis (Epi-LASIK). This study evaluates the histologic features and wound healing process of the corneal flap using Epi-Tome, which is the epithelial cutter of the newly introduced Epi-Lasik. METHODS: Twenty-four eyes of 12 dogs were devided into two groups. In one group (n=12), 20% alcohol was used and, in the other group (n=12), Epi-Tome (Gebauer, Germany) was used to make a corneal flap. The size change of a fluorescein-stained epithelial defect was followed postoperatively at 6, 12, 24, and 36 hours. RESULTS: The maximum decrease in defect size were observed at 0 to 6 hours in the Epi-Tome group, and from 6 to 12 hours in the alcohol group; the value were 10.01+/-5.32 mm2 and 9.23+/-4.75 mm2 respectively. Histologic review revealed that there was less tissue damage and smoother cut edge in the Epi-Tome group compared to the alcohol group, and the adhesion between stroma and epithelium was faster in the Epi-Tome group. CONCLUSIONS: Mechanically detached corneal flaps had favorable chances of survival such that re-epithelialization occurred early in the postoperative phase. A few epithelial fragments at a corneal section plane prevent corneal opacification and minimize inflammatory reaction, thus reducing postoperative pain.
Subject(s)
Animals , Dogs , Cornea , Epithelium , Pain, Postoperative , Re-Epithelialization , Refractive Surgical Procedures , Wound Healing , Wounds and InjuriesABSTRACT
The purpose of this workshop was to discuss on various issues for the development of a protocol for the Ja pan-Korea research collaboration. An important issue is to select/develop the experimental design of the clinical trial for individualized therapy done in Japan and Korea. Randomizedn-of-1 trial and randomization test were proposed as an possible candidate. A pilot study using randomized n-of-1 trial was done using intradermal acupuncture on pollinosis, and the methodological issues on the generalizability of randomized n-of-1 trial and the need of the selection of target disease were discussed. Onthe other hand, the literature survey has shown that the individualized acupuncture therapy is more effective than those of the standardized' fixed acupuncture therapy in usual RCTs. The diagnosis and selection of acupuncture point and method of manipulation were also shown to be an important factor. Further discussions will be required for the development of the adequate protocol for the individualized therapy.
ABSTRACT
Papillary carcinomas account for 85~90% of all thyroid cancers, with the tumor size considered an important prognostic factor. As the use of high-resolution ultrasonography and fine needle aspiration biopsy have increased, the diagnosis of papillary microcarcinomas of the thyroid gland; defined by the World Health Organization as being less than 1 cm in diameter, has increased. They are generally associated with an excellent prognosis, with distant metastasis being extremely rare. They usually remain clinically silent until their incidental histological diagnosis by autopsy or surgical material. The incidence discovered at autopsy varies between 3 and 36%. Cervical lymph node metastases from papillary microcarcinomas have often been discovered, which may be the first and sole manifestation of the disease, without clinical suspicion of a thyroid tumor. Herein, the case of a papillary thyroid microcarcinoma, diagnosed after a total thyroidectomy due to its first presentation as a contralateral cervical lymph node metastasis, without evidence of a clinical thyroid tumor, is described.
Subject(s)
Autopsy , Biopsy , Biopsy, Fine-Needle , Carcinoma, Papillary , Diagnosis , Incidence , Lymph Nodes , Neoplasm Metastasis , Prognosis , Thyroid Gland , Thyroidectomy , Ultrasonography , World Health OrganizationABSTRACT
PURPOSE: To evaluate the effectiveness of graded (adjustable intraoperatively) partial vertical rectus muscle tenotomy at the insertion in correcting small degrees of hypertropia. METHODS: All patients with best corrected visual acuity of better than 6/30 in both eyes who had undergone only partial tenotomy of vertical rectus muscle(s) over a 30-month period were included. Improvement was evaluated 6 weeks postoperatively as the change in alignment in prism diopters (PD) in primary gaze and in the field of action of the affected rectus muscle(s). Binocular function was evaluated by Titmus stereoacuity and the Worth 4-light tests. RESULTS: All 24 patients who met the inclusion criteria had diplopia preoperatively, and this had resolved in 17 (71%) postoperatively (P<0.005). Prisms were used by 6 preoperatively vs. 2 postoperatively (P<0.05). The average vertical deviation in primary gaze decreased from 8 PD to 2 PD (P<0.005). In the field of action of the treated rectus muscle, hypertropia decreased from an average of 8 PD to 3 PD (P<0.005). For the available pre- and post-operative assessments, stereoacuity improved after 10 of the 18 (56%) procedures and Worth 4-light testing showed improvement or maintenance of fusion after 13 of 19 procedures (68%). CONCLUSIONS: Graded vertical rectus partial tenotomy can effectively reduce small degrees of hypertropia and associated diplopia, improve binocular function, and reduce or eliminate the need for prism correction.