Extraocular muscle cysticercosis: clinical presentations and outcome of treatment.

PURPOSE: To report various clinical presentations and treatment outcomes in a series of patients with extraocular muscle cysticercosis. METHODS: This retrospective study reviewed the charts of 43 patients diagnosed with extraocular muscle cysticercosis with computed tomography and orbital B-scan ultrasonography between January 1991 and December 2002. Clinical presentation, results of investigations, treatment, and outcome were recorded. RESULTS: The superior rectus was the most commonly affected extraocular muscle. Restricted ocular motility was present in 88% of patients, and inflammatory signs were noted in the involved quadrant in 70% of patients. Eleven patients were treated with oral albendazole alone and 31 patients were treated with oral albendazole and prednisolone. Four extraocular muscle cysts were excised surgically, and five extruded spontaneously. Inflammatory signs subsided in all patients, and residual restriction of ocular motility was seen in 16 (50%) of 32 patients at a mean follow-up of 5 months. Type of treatment made no significant difference in the ocular motility outcome. CONCLUSIONS: Extraocular muscle cysticercosis should be considered in patients who present with restricted ocular motility and inflammatory signs. The direction of motility restriction does not indicate the muscle involved. Residual restriction of ocular motility is common despite the addition of corticosteroids to albendazole therapy.

Congenital unilateral adduction associated with jaw movement: a rare variant of trigemino-oculomotor synkinesis.

A 21-year-old man had abnormal adducting movements of his left eye on mastication. This suggested an anomalous innervation of the medial rectus muscle from the motor branch of the trigeminal nerve that innervated the external pterygoid muscle.

Successful occlusion therapy for amblyopia in 11- to 15-year-old children.

PURPOSE: To investigate the effectiveness of full-time occlusion therapy in treating amblyopia in 11- to 15-year-old children and to determine its lasting results. PATIENTS AND METHODS: Fifty-five compliant children 11 to 15 years old who had amblyopia were treated with full-time (during all waking hours) occlusion of their good eye until no further improvement in the visual acuity of their amblyopic eye was observed on 3 consecutive monthly follow-up examinations. After this, part-time (4 hours per day) occlusion therapy was used randomly in 24 of 55 patients for 3 to 6 months for maintenance of the final visual acuity. Snellen visual acuity and its logMAR equivalent were recorded before treatment, at the cessation of full-time occlusion therapy, and on the most recent examination. RESULTS: All 55 of the patients had improved visual acuity after treatment. The mean improvement was 0.46 logMAR unit (4.6 Snellen lines). Thirty-two of the patients had a mean follow-up of 17.6 months after the cessation of full-time and maintenance occlusion therapy. Twenty-nine (91%) of the 32 patients maintained improved visual acuity, whereas 3 (9%) exhibited a regression in visual acuity. Maintenance occlusion therapy did not have a significant stabilizing effect on the improved visual acuity. CONCLUSION: Compliant, full-time occlusion effectively improves acuity in children 11 to 15 years old who have amblyopia due to strabismus, anisometropia, or both. Most older patients have lasting improvement with or without maintenance patching.

Cyclic "V" esotropia.

A young girl had cyclic esotropia with cyclic inferior oblique overaction and "V" pattern. A recession-resection surgery of the horizontal rectus muscles and recession of the inferior oblique muscles cured the cyclic esotropia as well as the inferior oblique overaction and V pattern.

Keratoconus in Asian eyes at a tertiary eye care facility.

BACKGROUND: The purpose of this study was to assess the demographic variables, age at diagnosis, keratometry and slitlamp signs in keratoconus. METHODS: Thirty-one patients with 61 keratoconic eyes were selected provided they met one of two criteria: 1. They had an irregular corneal surface, Vogt's striae, Fleischer's ring or apical sub-epithelial corneal scarring characteristic of keratoconus; 2. Corneal topography revealed an average simulated keratometry of more than 45.2 D, central corneal power higher than 47.2 D or infero-superior asymmetry greater than 1.4 D. The main outcome measures were demographic variables, age at diagnosis, disease severity on keratometry and biomicroscopic signs. RESULTS: The patients' mean age at presentation was 20.2 +/- 6.4 years. Based on average keratometry values, 67.2 per cent of eyes had severe and 32.8 per cent had moderate keratoconus. Eyes with severe keratoconus presented at a younger average age (18.8 +/- 5.35 years) than moderate keratoconus (23.69 +/- 8.07 years). Thirty-eight eyes (92.5 per cent) with severe and 13 eyes (65 per cent) with moderate keratoconus demonstrated biomicroscopic signs of keratoconus. Twenty eyes (32.7 per cent) demonstrated apical sub-epithelial cornea scarring and 95 per cent of these eyes had severe keratoconus. CONCLUSIONS: The majority of keratoconic eyes in Asian-Indian patients demonstrate the severe stage of the disease by the second decade.

Anterior and posterior capsulorhexis in pediatric cataract surgery with or without trypan blue dye: randomized prospective clinical study.

PURPOSE: To evaluate the clinical efficacy of trypan blue 0.1% dye (Blurhex) in creating a complete anterior and posterior capsulorhexis during pediatric cataract surgery. SETTING: Tertiary eyecare center, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS: In a prospective randomized study, an anterior (ACCC) and posterior (PCCC) continuous curvilinear capsulorhexis were performed in pediatric patients. In Group 1 (n = 19), the ACCC and PCCC were created without use of trypan blue dye. In Group 2 (n = 23), intracameral trypan blue dye was used to stain the anterior and posterior capsules. RESULTS: In Group 1, 14 eyes (73.6%) had a complete ACCC and 10 (52.6%) had a complete PCCC. In Group 2, 21 eyes (91.3%) had a complete ACCC and 19 (82.6%) had a complete PCCC. CONCLUSION: In cases of pediatric cataract, staining the anterior and posterior capsules with trypan blue 0.1% allowed recognition of capsule flaps and facilitated the creation of complete ACCCs and PCCCs.

Factors predicting upshoots and downshoots in Duane's retraction syndrome.

PURPOSE: Factors predicting mechanical and innervational types of upshoots and downshoots in Duane's retraction syndrome were evaluated. METHODS: This retrospective study evaluated upshoots and downshoots in 196 patients (222 eyes) with Duane's retraction syndrome seen between January 1990 and July 2001. On the basis of the clinical characteristics, upshoots and downshoots were classified as mechanical type, innervational type, or both. Factors potentially predicting the upshoot-downshoot phenomenon that were studied included patient age, type of Duane's retraction syndrome, horizontal strabismus, and vertical tropia in the primary position of gaze. RESULTS: Upshoots and downshoots were present in 39% of the eyes. The mechanical type was more common than the innervational type (26% vs 12%). Overall, upshoots and downshoots were statistically significantly more common in type III Duane's retraction syndrome, with exotropia, and with vertical tropia in primary position. Patient age had no correlation with upshoots or downshoots. Both types of upshoots and downshoots were significantly more common in type III Duane's retraction syndrome. A statistically significant association was found between exotropia and the mechanical type, and between vertical tropia in primary position and the innervational type. CONCLUSIONS: All patients with type III Duane's retraction syndrome, exotropia, and vertical tropia in the primary position of gaze should be examined for upshoots and downshoots. One should look specifically for the mechanical type when there is exotropia and for the innervational type when there is a large vertical tropia in the primary position of gaze.

Indications and outcome of optical partial thickness lamellar keratoplasty.

PURPOSE: To review the indications and outcome of optical partial thickness lamellar keratoplasty (LKP) over a 22-year period. METHODS: The study is a retrospective review of 138 eyes of 126 patients. Snellen visual acuity, preoperative clinical condition, and postoperative clinical status were assessed. RESULTS: Postoperative follow-up ranged from 1 month to 174 months (average, 34.5). In descending order of frequency, climatic droplet keratopathy, infectious keratitis scar, and band-shaped keratopathy were the most common indications for surgery. Follow-up records were available for 130 eyes; 93% of grafts remained transparent. One hundred eyes (80%) preoperative measured Snellen acuity of 6/60 or less. Postoperatively, only 20 eyes (13.4%) were assessed as worse than 6/60. Mean best-corrected visual acuity postoperative was 0.58 +/- 0.24. Twenty-two eyes (16.9%) demonstrated postoperative visual acuity of better than 6/12. Complications included presumed rejection in two eyes, nonhealing epithelial defect in two eyes, and graft infection in seven eyes. CONCLUSION: Vision gain following LKP is generally moderate (visual acuity, 6/18-6/12) in the majority of eyes (61.5%). Vision-threatening complications are low (6.9%). There is scope for reducing complications like postoperative infections and improving visual gain through deep lamellar keratoplasty.

Vertical rectus recession for the innervational upshoot and downshoot in Duane's retraction syndrome.

PURPOSE: To report the results of recession of the vertical rectus muscle for the innervational upshoot and downshoot in Duane's retraction syndrome. METHODS: Ten patients who had Duane's retraction syndrome with innervational upshoot or downshoot underwent recession of the superior and inferior rectus muscle for the upshoot and downshoot, respectively. This procedure was combined with recession of the lateral rectus muscle(s) for exotropia in 6 patients and for the mechanical upshoot-downshoot in one patient. Postoperatively, the effects of surgery on the upshoot/downshoot, and horizontal and vertical deviation in the primary position were recorded. Average follow-up period was 1.2 years. RESULTS: Following surgery, the innervational upshoot/downshoot was eliminated in all patients. Mean vertical deviation in the primal position in 6 patients was reduced from 21.2 to 2.5 prism diopters and none of them developed a consecutive vertical imbalance. Four patients did not have a vertical deviation in the primary position preoperatively and one of them developed 10 prism diopters hypotropia following recession of the superior rectus muscle. CONCLUSIONS: Recession of the superior and inferior rectus muscle is a safe and effective treatment for the innervational upshoot and downshoot, respectively, in Duane's retraction syndrome.