Lower Nasal Quadrant Research Articles

Изменения микроперимерических параметров сетчатки при закрытии макулярного разрыва с сохранением внутренней пограничной мембраны

Purpose. To propose the technique of surgery and to conduct a comparative analysis of the microperimetric parameters of the retina for macular hole (MR) using various techniques. Material and methods. The results of surgical treatment of 90 patients (90 eyes) with a diagnosis of macular hole were analyzed. The patients were divided into two groups: group 1 – patients who underwent ILM peeling; group 2 – patients whose macular hole was closed with the preservation of ILM in the foveolar zone and nasal part. All patients underwent a standard ophthalmological examination and an OCT study. Results. On the 30th day after surgery, there was a statistically significant excess of microperimetric parameters from the nasal part of the macular zone: the upper nasal and lower nasal quadrants, where peeling was not performed (p = 0.032) and (p = 0.034), respectively. Conclusion. When conducting a membrane-preserving peeling technique, the risks of intraoperative damage to the retinal Сlayers are reduced. A higher functional result was obtained in comparison with the group where the standard technique was used. Keywords: microperimetry, macular rupture, peeling of the inner boundary membrane

Динамика изменений микропериметрических параметров сетчатки при различных методиках закрытия макулярных разрывов на основе аутопластики внутренней пограничной мембраны

Currently, vitreoretinal surgery is one of the most effective methods of treating macular holes that can improve the quality of vision, and the most common method of such treatment is vitrectomy with the removal of the internal border membrane around the rupture and the use of autoplasty of the internal border membrane. Microperimetric retinal testing measures the sensitivity of the retina at certain points on a larger surface and detects relative or absolute microscotomas, which allows you to objectively assess the state of the central part of the retina. At the same time, the search for ways to reduce the risk of macular surgery complications and improve functional results continues. Purpose. To propose a new technique for macular tear surgery, which is based on autoplasty of the VPM and reduction of microtraumatization of the retinal layers. Material and methods. The results of surgical treatment of 240 patients (240 eyes) with a diagnosis of macular holes were analyzed. All patients underwent surgical treatment for MH. Depending on the method of closing the macular hole, the patients were divided into two groups: group 1 – patients who underwent surgical treatment using the standard introverted flap technique. Group 2 – patients who were operated on according to the original method with partial peeling of ILM in the macular area. All parameters in the preoperative period were statistically comparable. Results. The most significant are the results obtained on the 30th day after surgical treatment. According to the results of surgical treatment, there was a significant excess of light sensitivity parameters in the nasal part of the pattern used: the upper-nasal and lower-nasal quadrants, where peeling was not performed. Conclusion. During this technique, there is a preservation ILM, which reduces the risk of intraoperative damage to the retinal layers. A higher functional result was obtained. Key words: microperimetry, macular rupture, ILM peeling.

Clinical Features of Iris Cysts in Long-Term Follow-Up.

This study evaluated the characteristics and clinical course of patients with iris cysts in the long-term follow-up (24–48 months). We retrospectively analyzed the medical records of 39 patients with iris cysts (27 women and 12 men). Age, visual acuity, intraocular pressure (IOP), slit-lamp evaluation, and ultrasound biomicroscopy images were assessed. The mean age at diagnosis was 40.6 ± 17.48 years. Thirty (76.9%) cysts were peripheral, five (12.8%) were located at the pupillary margin, two (5.1%) were midzonal, and two (5.1%) were multichamber cysts extending from the periphery to the pupillary margin. A total of 23 (59%) cysts were in the lower temporal quadrant, 11 (28.2%) were in the lower nasal quadrant, and 5 (12.8%) were in the upper nasal quadrant. Cyst size was positively correlated with patient age (rs = 0.38, p = 0.003) and negatively correlated with visual acuity (rs = −0.42, p = 0.014). Cyst growth was not observed. The only complication was an increase in IOP in three (7.7%) patients with multiple cysts. The anatomical location of the cysts cannot differentiate them from solid tumors. The vast majority of cysts are asymptomatic, do not increase in size, and do not require treatment during long-term follow-up.

Alterations in the Retinal Nerve Fiber Layer Thickness Color Map in Non-Glaucomatous Eyes with Myopia.

Objectives:To determine the normal values for retinal nerve fiber layer thickness (RNFLT) in myopic patients without glaucoma and analyze the changes in their color map.Materials and Methods:A total of 245 eyes without glaucoma were included in the study. According to the degree of myopia, the cases were divided into 4 groups: control group (+1.00/-1.00 D; n=70), Group 1 (-1.00/-3.00 D; n=50), Group 2 (-3.00/-6.00 D; n=75), and Group 3 (>-6.00 D; n=50). Intra-group comparisons were performed in terms of superotemporal, superonasal, nasal, inferonasal, inferotemporal, temporal, and global RNFLT (Heidelberg Spectralis, Optic Coherence Tomography, Germany) and the color coding of these quadrants (green: within normal limits, yellow: borderline, red: outside normal limits).Results:All groups were similar in age and gender (p>0.05). As the degree of myopia increased, RNFLT became thinner in the upper and lower temporal and upper and lower nasal quadrants (p<0.01). The rate of measurements considered borderline and outside normal limit in at least 1 quadrant was higher in groups with higher myopia for all quadrants (p<0.05). This rate was found to be 8/70 (11.4%) for the control group, 9/50 (18.0%) for Group 1, 21/75 (28.0%) for Group 2, and 33/50 (66.0%) for Group 3 (p<0.01).Conclusion:The high rate of RNFLT classified as borderline or outside normal limits in myopic patients is a finding to which clinicians should pay attention in order not to make a misdiagnosis, especially in cases of suspected glaucoma.

A Rare Case Report of Unilateral Twin Crystalline Lenses

We report a rare case of congenital twin crystalline lenses in an eye. The longest visible iris diameter was oblique, drawn from temporal to nasal quadrant making cornea horizontally oval. The crystalline lenses were found to be situated obliquely on the horizontal axis in the upper temporal and lower nasal quadrant.

The efficacy of microperimetry and contrast sensitivity test in the diagnosis of optic chiasm compression due to pituitary adenomas.

The aim of the study was to determine which microperimetry and contrast sensitivity test parameters would prove the most valuable during diagnosing optic chiasm compression due to pituitary adenomas. A control group comprised healthy individuals (Group 1). Patients with pituitary macroadenoma were divided into two groups: Group 2 - absent optic chiasm compression; and Group 3 - present optic chiasm compression detected on contrastenhanced magnetic resonance imaging (MRI). Each group comprised 20 patients (40 eyes), i.e. a total of 60 patients (120 eyes) were examined. A complete ocular examination, intraocular pressure, microperimetry, contrast sensitivity test, kinetic Goldmann visual field, and static Octopus visual field test were performed. Group 1 and 2 variables showed no statistically significant differences with respect to the mean sensitivity (MS) and mean defect (MD) in microperimetry. After dividing the microperimetry area into quadrants, a difference was shown in the mean sensitivity of the lower-nasal quadrant (MS LN) and mean defect of the lower-nasal quadrant (MD LN) between those groups. Receiver operating characteristic (ROC) curves analysis revealed that the microperimetry parameter - MS LN as well as row D and E contrast sensitivity test could be highly specific in the assessment of early damage of the optic nerve in patients suffering from pituitary adenoma. Microperimetry and contrast sensitivity test are non-invasive diagnostic investigations adjunctive to MRI, which facilitate detection of early chiasmal compression caused by pituitary adenomas.

Pseudoexfoliation syndrome and episcleral venous pressure

Introduction. Pseudoexfoliation syndrome (PEX) is a relatively widespread generalized age-related disease, in which abnormal fibrillar extracellular material is produced and accumulates in many tissues including vessels. Glaucoma occurs more commonly in eyes with PEX than in those without it. Episcleral venous pressure (EVP) is an important determinant of intraocular pressure (IOP). It seems reasonable to evaluate episcleral venous pressure in patients with PEX. Purpose. To evaluate episcleral venous pressure in patients with PEX. Methods. 540 eyes of 270 patients were enrolled in the prospective study. We evaluated episcleral venous pressure. Results. EVP in total vein compression in lower-nasal quadrant (mmHg) in main group(with PEX) was 14.0±3.29, in control group No. 1 (non PEX, adults) - 14.38±3.77, in control group No. 2 (non PEX, young) - 10.91±2.34. EVP in total vein compression in lower-temporal quadrant (mmHg) in main group was 15.1±3.31, in control group No. 1 - 15.76±3.45, in control group No. 2 - 11.00±2.16. Difference in episcleral venous pressure between main group and age-matched control group No. 1 was not significant, and between main group and control group No. 2 was significant. Conclusion. EVP level is not influenced by PEX, but is influenced by age.

Optic nerve and retinal damage in a patient with post-hemorrhagic anemia

There is a number of literature data on ischemic optic neuropathy development in acute hemorrhage. However, ocular disorders in prolonged chronic hemorrhage and iron-deficiency anemia are not well studied. We present a clinical case of optic nerve and retinal damage in a patient with prolonged chronic gastrointestinal bleeding. 53-year-old patient S. presented with complaints on dramatic sudden loss of vision of his right eye (visual acuity was 0/02 and was not improving with correction). Visual acuity of the left eye was good. Ophthalmoscopy revealed right optic nerve swelling, flame-shaped disc and peripapillary hemorrhages, and multiple soft exudates along blood vessels of the right eye. Optic nerve head of the left eye was pale pink, with well-defined borders. Multiple soft exudates along blood vessels and few flame-shaped hemorrhages were identified as well. Clinical examination revealed iron-deficiency post-hemorrhagic anemia. The diagnosis of anterior ischemic neuropathy of the right eye, ischemic neuroretinopathy of left eye associated with post-hemorrhagic anemia was established. Conservative treatment increased hemoglobin level up to 82 g/l, the red blood cells count - up to 2,88×1012/L, hematocrit was 0.25%, platelet count reached 344×109/L, but the signs of rectal bleeding remained. The patient underwent surgery for hemorrhoids. After the increase of hemoglobin level, visual acuity of the right eye improved to 0.1, the visual acuity of the left eye was 1.0. According to the results of computed peripheral vision test (Humphrey Full Field 120 Point Screening Test), central scotoma and scotomas in the lower half of the field of vision of the right eye remained. In the field of vision of the left eye, the area of absolute arcuate scotoma in the lower-nasal quadrant decreased significantly. Reduced visual acuity was the main complaint of the patient with a longstanding gastrointestinal bleeding. A careful history and thorough clinical examination allowed to establish the cause of the optic nerve and retinal damage, to assign pathogenetically based treatment, which led to an improvement in visual function.

Multifocal Visual Evoked Potentials (mfVEP) in Diabetic Patients with and without Polyneuropathy

Previously not shown this study support that mfVEP is an indicator of optic nerve neuropathy in diabetic patients and there could be a correlation between the optic nerve dysfunction and diabetic poly neuropathy. The early optic nerve involvement might explain some of the visual complain in this group of diabetic patients.Purpose:To investigate the function of the visual pathway measured by mfVEP (multifocal Visual Evoked Potentials) in patients with diabetic retinopathy and neurophysiologically verified polyneuropathySubjects and Methods:Thirty-two diabetic patients with the same degree of diabetic retinopathy were classified with neurography regarding polyneuropathy and further examined with mfVEP. The mfVEPs of eighteen patients with polyneuropathy were compared to those of fourteen diabetic patients without polyneuropathy and to those of ten nondiabetic subjects.Results:Diabetic duration, and the number of patients who had undergone panretinal photocoagulation for proliferative diabetic retinopathy were similar in the two patient groups, 29±13 vs 25±7 years, p=0.3.Both groups of patients with diabetic retinopathy had significantly lower amplitudes in the mfVEP than the healthy subjects.In addition the mfVEP amplitudes, which reflect selected areas of the visual function, were significantly reduced in the lower nasal quadrant in patients with neuropathy compared to patients without neuropathy.Conclusion:The results indicate that mfVEP could be an indicator of optic nerve neuropathy in patients with diabetic retinopathy. The early optic nerve involvement might explain some of the visual complaints in this group of diabetic patients.

Cataract frequency and light scattering profiles in retired members of light protected communities ‐ The Irish Nun Eye Study (INES)

Abstract Purpose Investigation of cataract frequencies, yellow discoloration and light scattering profiles in the lenses of a subset of nuns from the Irish Nun Eye Study (INES) correlated to age and outdoor activity. Methods After obtaining informed consent, the anterior eye segment of 144 retired nuns from contemplative and missionary convents in Northern Ireland and the Republic of Ireland were monitored with a Scheimpflug camera (Pentacam HR®, Oculus, Wetzlar, Germany). Images of the cornea and lens were recorded automatically in 25 meridians in mydriasis, using the recording algorithm of the camera. In addition retro‐images of the lenses were recorded using the Neitz Cataract screener and lens discoloration was recorded using a manual slitlamp and the LOCS III grading system. Image analysis was performed using special analytical software (BIOM®) and cataract classification was done using the Bonn cataract classification system. Results Age‐related light scattering increase is most pronounced in the anterior deep cortex and the anterior nuclear shell of the lenses and is generally lowest in the posterior nuclear shell. Cortical cataracts were the most frequent type in this study, the highest frequency found in the lower nasal quadrant followed by the lower temporal quadrant. Pure subcapsular cataracts have not been found in this study. The increase in yellow discoloration correlated to the increase in nuclear light scattering. Nuns with cortical cataracts had less discoloration, but were also younger. Conclusion The frequency of nuclear cataracts was lower in the INES cohort was lower, but the amount of cortical cataracts was similar to other studies like Beaver Dam Eye Study. The increases in nuclear light scattering and discoloration correlated with age and exposure index. The data from the INES study support the hypothesis that light protection has a positive effect on the frequencies of nuclear and subcapsular cataracts as well as on lens discoloration. The Pentacam HR® provided better documentation of lens transmission characteristics than the Neitz cataract scanner.

Impact of iris pigment and pupil size in ultraviolet radiation cataract in rat

To investigate the effect of iris pigment and pupil size in ultraviolet radiation (UVR)-induced cataract. Brown-Norway rats (pigmented) and Fischer-344 rats (non-pigmented) were unilaterally exposed in vivo to 5 kJ/m(2) UVR. Each strain was split into two groups, each receiving either mydriatic (tropicamide) or miotic (pilocarpine) eye-drops. One week after exposure, the degree of ocular inflammation and damage in the anterior segment was determined. The lenses were extracted, photographed and the degree of forward light scattering (cataract) was quantified. The cataract types differed between the two strains. All Fischer rats developed macroscopically identifiable UVR cataract while only 41% of Brown-Norway rats did so. All groups except the miotic Brown-Norway developed significant light scattering. The Fischer rats developed 3-4-fold more lens light scattering than the Brown-Norway rats. The miotic Fischer group exhibited significantly more light scattering than the mydriatic Fischer group. There was no significant difference in light scattering between the two Brown-Norway groups. There was a correlation between ocular inflammation and degree of light scattering, with Brown-Norway rats exhibiting less inflammation and lens light scattering. Pigmented rats develop less UVR cataract and less ocular inflammation than non-pigmented rats. Pupil size plays a smaller role in UVR cataract development in pigmented rats than in non-pigmented. The role of UVR-induced ocular inflammation in cataract development is still ambiguous.

Optimized Zernike Term Selection in Customized Treatments for Laser Corneal Refractive Surgery: Case Report

To report a case in which a tissue saving program in an aberrated eye was used. A new algorithm for the selection of an optimized set of Zernike terms in customized treatments for laser corneal refractive surgery was developed and clinically tested. Ablation was performed using the SCHWIND ESIRIS excimer laser. Pre- and postoperative corneal wave aberrations were analyzed using the Keratron Scout videokeratoscope (Optikon 2000). Required ablation was reduced by approximately 15% compared to full customized correction. Refraction was corrected to subclinical levels, uncorrected distance visual acuity improved to 20/20, corrected distance visual acuity gained 2 lines, aberrations were reduced by approximately 40% compared to preoperative baseline levels, and the functional optical zone of the cornea was enlarged by approximately 40% compared to preoperative baseline levels. Trefoil, coma, spherical aberration, and the root-mean-square value of the higher order aberrations were reduced. Eliminating all higher order aberrations may not optimize visual function in highly aberrated eyes. The new algorithm minimized tissue removal in refractive surgery but further clinical evaluations are required to confi rm preliminary results.

Glaukos iStent® trabecular micro-bypass

The iStent trabecular micro-bypass system (Glaukos Corp. Laguna Hills, CA) was developed to address the limitations of current medical and surgical therapies for glaucoma treatment. The iStent® is inserted ab interno through a small temporal clear corneal incision, bypassing the trabecular meshwork and placed in Schlemm's canal at the lower nasal quadrant. Implantation of this stent into Schlemm's canal allows aqueous humor to drain directly from the anterior chamber into Schlemm's canal bypassing the obstructed trabecular meshwork. For this review, a Medline search was performed using the terms “trabecular micro-bypass stent” and “trabecular bypass stent.” The online abstract database for the American Academy of Ophthalmology was also reviewed. s which duplicated published articles were excluded. All relevant papers (n is equal to three) and abstracts (n is equal to one) were included in this review. Multiple, prospective multi-country, clinical trials have demonstrated the safety and efficacy of iStent in reducing IOP, when compared to traditional treatment modalities, while reducing/ eliminating the need for ocular antihypertensive drugs when implanted in OAG patients during combined cataract surgery or in patients with glaucoma refractory to traditional treatment modalities.

Long-term fluctuation of retinal sensitivity during pregnancy

Background: We investigated the effect of pregnancy on the long-term fluctuation of retinal sensitivity in healthy women. Methods: Candidates for the study were healthy women who were likely to become pregnant. A complete ocular examination of both eyes was performed in 41 women, and 1 eye each was chosen at random for the study.This initial examination included 2 sets of visual field measurements consisting of 5 individual measures done at least a day apart. After pregnancy, ocular examinations were repeated once between 10 and 15 weeks of gestation and once between 29 and 34 weeks. The mean threshold sensitivity (MS) of the visual field and the coefficient of variation of MS measurements for upper temporal, upper nasal, lower temporal, and lower nasal quadrants were calculated in each series. Results: The visual field MS of the subjects increased significantly in the third trimester ( p < 0.01).The coefficient of variation of the visual field MS measurements did not change significantly in the nasal quadrants. However, it decreased significantly in both upper and lower temporal quadrants. Interpretation: Visual field MS and the reproducibility of MS measurements for temporal visual field increased significantly in the third trimester of the pregnancy. Further studies on the role of pregnancy-related ocular hemodynamic changes may provide insight into the etiopathogenesis of hormone-related processes.

Número, tipo e topografia dos pontos de vazamento em pacientes com coriorretinopatia serosa central

To evaluate the number, shape and topography of leakage points in patients with central serous chorioretinopathy (CSC). Digital photographic files of fluorescein angiography with the diagnosis of CSC were reviewed by the author. The cases considered in remission and the examinations related to the same episode were excluded. The author filled out a form containing medical record number, initials, sex, age, date of the examination and leakage point characteristics (number, shape, and topography) of the selected cases. The examinations of 418 patients (455 eyes) were included, with a male:female ratio of 2.32:1. Ninety-one point fifteen percent of the patients presented the disease unilaterally and 8.85% bilaterally. The mean age was 43.04 years (range, 19-68 years). Among the 455 selected eyes, 88.35% presented typical forms of CSC while 10.11% decompensation of the retinal pigment epithelium and 1.54% with isolated retinal pigment epithelium (RPE) detachment. The evaluation of typical forms of CSC showed a leakage point with uniform dye spread (inkblot) in 88.81% and 11.19% with a smoke-stack phenomenon. Regarding the leakage points, 46.01% were located in the upper nasal quadrant, 23.27% in the upper temporal quadrant, 19.18% in the lower nasal quadrant, 11.01% in the lower temporal quadrant and 0.53% in the subfoveal area. In our series men were affected approximately two times more often then women, most of them with a unilateral involvement and in around the fourth decade of life. About 90% of the patients presented the typical forms, with 1 or 2 inkblot points or leakage. The superior nasal quadrant was the most affected. The isolated RPE detachment rarely occurred. Decompensation of RPE affected about 10% of the patients.

Localization of cortical cataract in subjects of diverse races and latitude.

To compare the characteristics of early cortical cataract localization in three groups in cataract epidemiologic surveys performed in Reykjavík, Melbourne, and Singapore. Individuals who had right eyes with an area of cortical opacity less than 20% of the pupil when dilated 7 mm or more were selected as subjects. This included 197 subjects from the Reykjavík Eye Study, 231 from the Vitamin E, Cataract, and Age-Related Maculopathy (VECAT) study in Melbourne, and 92 from the Singapore-Japan Cooperative Cataract Study, all showing early-stage cataract in pupils dilated to 7 mm or more. Scheimpflug and retroilluminated photographs were used to locate opacities. Localization of cortical cataract was determined by dividing the retroillumination image into seven concentric circles with diameters of 1 through 7 mm, and eight sections of 45 degrees radial octants. The positive rate of opacification was then calculated for each quadrant. The highest positive rate of opacification was observed in the lower nasal quadrant in all groups. The relative risk of the prevalence of cortical opacity in the lower nasal oblique hemisphere to the upper temporal oblique hemisphere was the highest in the Singaporean subjects followed by those of Melbourne and then of Reykjavík. The prevalence of cortical cataract was higher in the lower nasal quadrant than in the other quadrants for all subjects of diverse race in three climatically different locations. This higher prevalence was most pronounced in subjects living at low latitude. These results support the view that solar UV exposure is a possible risk factor for development of human cortical cataract.

Optic nerve head blood flow using scanning laser Doppler flowmetry after laser in situ keratomileusis.

To investigate ocular blood flow changes following laser in situ keratomileusis (LASIK) in myopic eyes. Seventeen eyes of ten myopic patients were included in the study. Mean age of the seven men and three women was 29.1+/-2.5 years. Mean spherical equivalent refraction was -7.70+/-2.52 D. LASIK was performed with the Hansatome microkeratome and Summit SVS Apex excimer laser. Optic nerve head blood flow was measured by using the Heidelberg Retinal Flowmeter preoperatively and postoperatively at 1 day, 1 week, and 1 month. Preoperative ocular blood flow data (blood flow, volume, velocity) were compared with postoperative data using variance analysis. Correlation analysis was performed for age of patients, suction time, and ocular blood flow data. Mean suction time was 19+/-7 seconds. There was no significant correlation between suction time, age, and ocular blood flow. We found an increase in blood flow at the lamina cribrosa taken 1 day postoperatively (P=.04). Blood flow returned to preoperative values at the 1-week and 1-month measurements in the lamina cribrosa region. There was no significant change in ocular blood flow data in the neuroretinal rim except an increase in velocity at the lower nasal quadrant on postoperative day 1 (P=.03). LASIK caused a temporary increase in blood flow at the lamina cribrosa region of the optical nerve head in healthy myopic eyes. The increase in blood flow may suggest a compensatory change for maintaining blood flow in the ocular nerve head following LASIK-induced ischemia.

Congenital double crystalline lenses

We report an unusual case of an eye with 2 congenital crystalline lenses; ie, a duplicated lens. The horizontal axis of the eye was obliquely placed. One lens was situated in the upper temporal quadrant and the other, in the lower nasal quadrant. One lens was larger than the other.

Changes in Choroidal Innervation in Royal College of Surgeons Rats with Hereditary Retinal Degeneration

In Royal College of Surgeons (RCS) rats with hereditary retinal degeneration loss of retinal pigmented epithelium (RPE) and choriocapillaris is most pronounced in the upper-temporal quadrant. To investigate whether changes in choroidal vasodilative innervation might be involved in the RPE degeneration, we analyzed whole mount preparations of the retina and choroid stained for nitric oxide synthase and for NADPH-diaphorase (d) of 19 dystrophic RCS rats and 24 age-matched congenic controls of different age groups. Density of NADPH-d-positive nerve fibers was quantitatively evaluated in the upper-temporal and lower-nasal quadrant. Our results revealed that even in control animals there were much less positively stained nerve fibers in the upper-temporal than in the lower-nasal quadrant. Nerve fiber density in both quadrants increased for up to 3 months and remained nearly constant throughout life. In the dystrophic animals up to 3 months of age nerve fiber density was similar to that seen in the controls. In dystrophic animals older than 3 months nerve fiber density in the upper-temporal quadrant decreased significantly, whereas density in the lower-nasal quadrant revealed nearly the same values as in the age-matched controls. Decrease of NADPH-d stained nerve fibers in this quadrant occurred prior to the vascular changes in the choriocapillaris. In the retina of RCS dystrophic rats an increase of NADPH-d-positive amacrine cells was found only in 3-month-old animals. Most of these cells were located in the vicinity of irregularly arranged branches of the central retinal artery. In animals 5 months of age and older the number of cells decreased to the same values found in controls, so that we assume that increase of NADPH-d-positive amacrine cells is involved in capillary degeneration or sprouting.

Recurrent intrascleral cyst after strabismus surgery

Intrascleral epithelial inclusion cysts have been described after ocular trauma, scleral buckling and strabismus surgery. They are usually small, asymptomatic and located anteriorly. The clinical history of a 9-year-old girl who developed a huge epi- and retrobulbar intrascleral cyst in both the upper and the lower nasal quadrants after multiple strabismus operations is described. Surgical resection of the cyst wall was twice unsuccessful. Drainage of the cyst, followed by the injection of tetracycline (30 mg/ml) in the cyst site, led to complete recovery. Recurrent posteriorly located intrascleral cyst can occur after strabismus surgery. Therapy consisting of drainage combined with intrascleral administration of tetracycline solution (30 mg/ml) to induce sclerodesis appeared to be effective during a 2-year follow-up period.