Upper-eyelid retraction is a common sign of thyroid-associated eye disease (TAED), and these patients are highly bothered by the appearance of their eyes. In this study, botulinum toxin A (BTA) was injected into the levator palpebrae superioris muscle in 8 eyes of 4 patients in an attempt to control the abnormal elevation of the upper eyelid. BTA provided control of the upper-eyelid retraction, and the cosmetically acceptable effect lasted for 3–4 months. It was concluded that BTA is an effective method of treatment in this condition. Since it has a temporary effect, it can safely be used to provide relief of symptoms related to upper-eyelid retraction during unstabilized periods of TAED, which may last as long as several years in some patients.
Hydatid disease is primarily a disease of sheep and cattle. Human beings are accidental hosts. We present a 32-year-old multigravida at 25 weeks of pregnancy in whom splenic and liver cysts were diagnosed by ultrasonography and magnetic resonance imaging (MRI). The splenic cyst was removed and a healthy baby was delivered vaginally at term.
Correlation was found between initial visual acuity and the funduscopic appearance after the 2nd week. Fluorescein angiography was not found to be a conclusive test in solar retinopathy. No late complications were observed.
In an attempt to evaluate the response to surgical treatment, the surgical outcome of 16 patients with Duane's retraction syndrome (DRS) was investigated. Single horizontal rectus muscle recession, transposition of vertical recti and recession of both horizontal recti were carried out. In one of the four patients with significant globe retraction, Y splitting of the lateral rectus muscle was added to the procedure to overcome the cosmetically unacceptable upshoot. Single horizontal muscle recession surgery was effective in reducing the abnormal head posture and the deviation in primary position. The results of both horizontal recti recession were not so predictable in reducing globe retraction. Recession of both horizontal recti was ineffective in vertical DRS. It is suggested that the variability of surgical outcome in DRS may be related to the different innervational patterns and mechanical factors.
The effect of surgery in highly asymmetric dissociated vertical deviations (DVD) was evaluated in 13 patients. All the patients had a moderate or large DVD (more than 15 PD) in one eye with a latent or very small (less than 5 PD) DVD in the fellow eye. As there was no strong fixation preference in either of the two eyes of the patients before surgery, bilateral surgery was performed. Eleven patients underwent surgery which consisted of conventional (3-5 mm) superior rectus (SR) recession combined with posterior fixation sutures placed 13 mm from the original insertion in the eye with moderate or large DVD, with posterior fixation sutures alone in the eye with minimal or latent DVD. In the remaining two patients, bilateral conventional SR recessions were combined with posterior fixation sutures. The mean follow-up was eight months. A cure was defined as latency or elimination of the hyperdeviation and was noted in five patients, two of whom had undergone bilateral SR recessions with posterior fixation sutures. All the remaining eight patients developed a cosmetically unacceptable moderate or large DVD (more than 15 PD) in the eye that had a very small DVD prior to surgery, two of them having a manifest comitant hypertropia postoperatively in addition to the DVD, demonstrating overcorrections with the previously elevated eye now in a hypotropic position. Performing posterior fixation sutures alone to the eye with a very small DVD does not seem to be effective in the surgical treatment of DVD; combining posterior fixation sutures with a recession of the SR muscle seems to be a more reasonable approach.
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