Surgical correction of caruncular distortion after medial rectus resection.

Strabismus surgery can lead to successful eye alignment but may cause scarring and distortion of conjunctiva and adjacent structures in some cases. We report two patients who developed epiphora when the lacrimal caruncles became distorted after strabismus surgery. Both cases followed successful medial rectus muscle resections for exotropia. A simple excision of the caruncles improved the epiphora and produced a satisfactory appearance.

Magnetic resonance imaging of the extraocular muscle path before and after strabismus surgery for a large degree of cyclotorsion induced by macular translocation surgery.

PURPOSE: To evaluate the changes in the location of the extraocular muscles (EOMs) following strabismus surgery to treat a large degree of torsional diplopia induced by macular translocation surgery. METHODS: Six consecutive patients who underwent macular translocation surgery with 360 degrees of retinotomy and subsequent strabismus surgery were studied. Magnetic resonance imaging (MRI) was performed before and after the surgery. The angle made by the line connecting the center of the orbit and the center of each rectus muscle and the horizontal was measured. The changes in these angles before and after strabismus surgery were studied. RESULTS: The average rotation of the globe after strabismus surgery was 28 degrees (SD = 7.21; range, 17 degrees -39 degrees ). The average measured EOM shift was -0.3 degrees (SD = 8.04; range, -20.4 degrees to 20.2 degrees ). CONCLUSIONS: Despite large torsional rotation of the globe, there was no corresponding torsional repositioning of the deep paths of the rectus muscles. The paths of the operated muscles were essentially unchanged.

Strabological findings after macular translocation surgery with 360 degrees retinotomy.

PURPOSE: To examine the strabological findings after macular translocation surgery with a 360 degrees retinotomy. METHODS: Thirty-two patients who underwent macular translocation surgery were divided into three groups based on their responses to the Bagolini striated lenses test: fusion, ignoring the image, and diplopia. The relevant factors affecting binocularity were compared among the three groups. RESULTS: Five patients had peripheral fusion and three of these had gross stereopsis. Fifteen patients ignored the second image, and 12 patients had diplopia. The objective angle of macular rotation was smaller in the patients with peripheral fusion (15.0 +/- 6.1 degrees) than in those with diplopia (32.7 +/- 11.7 degrees). The subjective angle of cyclotorsion in those with peripheral fusion (6.0 +/- 4.2 degrees) was smaller than in those who ignored the image ("ignoring" group; 20.5 +/- 9.19 degrees) and the diplopia group (30.7 +/- 12.8 degrees). The amount of torsional sensory compensation in patients with diplopia (2.08 +/- 3.83 degrees) was significantly smaller than in those with peripheral fusion (9.00 +/- 7.42 degrees) and in the ignoring group (6.73 +/- 3.86 degrees). Patients with peripheral fusion were significantly younger (54.2 +/- 14.3 years) than those in the ignoring group (67.7 +/- 10.0 years) and those with diplopia (68.0 +/- 5.4 years). CONCLUSIONS: Adaptive mechanisms are activated to reduce the surgically induced objective angle of cyclotorsion, and a cyclodeviation of 15 degrees was the critical angle separating those who had peripheral fusion from those who did not. This value corresponds to the cyclofusional amplitude in normal adults.