To determine the precise site of reattachment of recessed muscles, 4-mm conventional and hang-back recessions of the inferior rectus muscle were performed in 18 albino rabbits. Six weeks later, the distance from the anterior border of the reattached muscle to the insertion was measured both grossly and microscopically. In all cases the operated muscles had advanced minimally from the site of surgical placement. Gross observation showed that the mean forward creep was significantly greater for those rabbits which underwent hang-back recession (1.81 +/- 0.67 mm) than for those that were submitted to the conventional technique (0.83 +/- 0.38 mm). Measurements done on histological sections revealed that the mean distance of the anterior border of the muscle fiber from the reference suture was larger for conventional recession (2.73 +/- 0.75 mm) than for hang-back recession (1.91 +/- 0.72 mm).

Abstract. Graves' disease is a rare disorder in children, particularly in infants. Ocular manifestations of Graves' disease in children are even more rare and are mild compared to adults. We report a 3-year-old girl with Graves' ophthalmopathy who visited our clinic because of lacrimation. Her family had also noticed exophthalmos, goiter, irritability and increased appetite for more than 3 months. The ophthalmologist noted bilateral proptosis, eyelid erythema, lacrimation, entropion of the lower eyelid, and superficial keratitis. Her serum concentrations of free thyroxine and free triiodothyronine were high, and thyroid-stimulating hormone (TSH) was low. Serum samples were markedly positive for antibodies to TSH receptor (TRAb) and thyroid-stimulating antibody (TSAb). Although hyperthyroidism was controlled with propylthiouracil within 3 weeks, her eye signs did not improve. We administered methylprednisolone pulse therapy for ophthalmopathy, but the effect was limited and the lacrimation due to entropion and superficial keratitis persisted. Titers of both TRAb and TSAb decreased slightly and transiently with the pulse therapy. One year later, both titers remained high and eye signs did not improve any more though she was clinically euthyroid. This might indicate that both TRAb and TSAb levels correlate with the clinical course. Therefore, TRAb or TSAb might be good indicators of progress of Graves' ophthalmopathy. Ocular manifestations of Graves' disease should be followed closely with measurements of both TRAb and TSAb even in infant cases.