PMC5720042_01
Preoperative findings.. Notes: (A) Preoperative images of the nine diagnostic gaze positions in a female patient with filamentary keratitis. Prior to surgery, hypertropia was detected in the primary gaze position of her left eye. The patient's right eye was found to have upper rotation imperfection at the inside and outside transposition. (B) Preoperative slit-lamp examination image of the patient's left eye. The upper-third or more area of the cornea was covered to the upper eyelid due to an upper squint. (C) A thread-like inflammation of the cornea in the upper-third area of the patient's left eye. (D) Fluorescein staining of the left eye cornea. (E) Hess chart shows an upward restriction on the right eye.
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Her right eye was the dominant eye, with imperfect upper rotation at the inside and outside transposition (Figure 1A) and positive Bell's phenomenon. Slit-lamp examination of her left eye revealed filamentary keratitis in more than one-third of the upper cornea behind the upper eyelid (Figure 1B-D). An upward restriction of right eye was shown using Hess chart (Figure 1E).
Postoperative findings.. Notes: (A) Images of the patient's nine diagnostic gaze positions at 3 weeks post operation. Her ocular muscles became orthophoria in the primary gaze position, and strabismus significantly decreased in all gaze directions. Her right eye performed upper rotation improved at the inside transposition. (B) Anterior ocular segment findings in the patient's left eye at 3 weeks post operation revealed no filamentary keratitis. (C) Fluorescein staining of the left eye cornea. (D) Hess chart shows improvement of uplift limit of right eye.
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Following surgery, the left eye squint angle was improved to 5Delta hypertrophic (Figure 2A). The filamentary keratitis of the left eye disappeared, and there was no recurrence over the following 5 years (Figure 2B, C). After the surgery, uplift limit of right eye was improved (Figure 2D).