Surgical treatment of residual esotropia.

Residual esotropia is a common problem following bilateral medial rectus (MR) recessions for esotropia. The patient was 30 years old men who underwent bilateral MR recession of both eyes in the childhood. Recession was repeated on the right eye few years after the first surgery, but residual esotropia progressed. Prior to our surgery residual angle of esotropia was 50PD degrees with restriction of abduction and elevation of the left eye. Sinechiolysis et myectomia of right MR and sinechiolysis and recession of left MR were performed using operating microskop. One week after surgery residual angle was 4 PD. Motility of both eyes was free except slight residual reduction of left eye elevation. During postoperative period of 2 years residual angle was not greater than 8 PD, with good motility of both eyes. We suggest that sinechiolysis and myectomia of MR together with recession of the prior operated muscle, when possible, can be a reasonable surgical option in the treatment of large-angle residual esotropia.

Trichophyton Spp. fungal keratitis in 22 years old female contact lenses wearer.

Fungal keratitis represents one of the most difficult forms of microbial keratitis to diagnose and treat successfully. It is difficult to obtain correct diagnosis and topical antifungal preparations. Fungi can cause severe stromal necrosis and enter the anterior chamber by penetrating an intact Descemet membrane. The most common pathogens are filamentous fungi (Aspergillus and Fusarium spp.) and Candida albicans. The incidence of Trichophyton spp. keratitis is 5%. A 22 years old female contact lenses wearer after keratitis developed corneal melting syndrome, spontaneous perforation of the cornea and complicated cataract of the left eye. Conjunctival swab was sterile as well as first sample of corneal tissue and sample from the anterior chamber. Urgent therapeutic perforating keratoplasty (PK), was performed together with extracapsular cataract extraction and the implantation of the intraocular lens in the posterior chamber. The patient was treated with ciprofloxacin and diflucan (systemic therapy); with dexamethason and atropin (subconjunctivaly) and chlorhexidine, brolene, levofloxacin, polimyxin B, and dexamethason/neomycin (topically). Microbiology evaluation was performed once again following excisional biopsy of the intracameral portion of the lesion. The presence of Trichophyton spp. was finally confirmed. Itraconazole and garamycin were included in the systemic therapy. Corneal graft was clear for 17 days but decompensated 28 days after the PK. After two weeks microorganisms invaded the vitreous and caused endophthalmitis. Despite urgent pars plana vitrectomy patient developed endophthalmitis, lost light sensation and developed phthysis. Evisceration and the implantation of silicon prosthesis was done. Perforating keratoplasty is a method of choice in treating severe infectious keratitis unresponsive to conservative treatment but without the eradication of microorganisms it cannot restore the vision or save the eye. Trichophyton spp. may cause a severe disease of the anterior and posterior part of the eye which may finish with the lost of vision/eye. Prompt diagnosis and treatment of Trichophyton spp. keratitis are essential for a good visual outcome.