Transcanalicular Multidiode Laser Versus External Dacryocystorhinostomy in the Treatment of Acquired Nasolacrimal Duct Obstruction.

OBJECTIVES: This study was a comparison of the outcomes of transcanalicular multidiode laser dacryocystorhinostomy (TCLDCR) and external dacryocystorhinostomy (EXDCR) treatment for patients with acquired nasolacrimal duct obstruction. METHODS: Thirty-one consecutive patients who underwent TCLDCR (TCLDCR group) and 68 consecutive patients who underwent EXDCR (EXDCR group) due to acquired nasolacrimal duct obstruction were enrolled in the study. Follow-up visits were performed on the first day, and at the first week, first month, third month, sixth month, and every six months thereafter. Surgical success was defined as achievement of a patent osteotomy and a successful bicanalicular silicone intubation during the procedure. Anatomical success was defined by observation of a patent osteotomy on lacrimal irrigation, regardless of epiphora. The surgery time and intra- and postoperative complications were noted for each patient. RESULTS: The TCLDCR group had a significantly shorter mean surgery time (27.9±5.5 minutes) compared with the EXDCR group (58.5±12.0 minutes) (p<0.001). However, the mean anatomical and functional rates of TCLDCR (58.0% and 54.8%, respectively) were significantly lower than those of the EXDCR group (94.1% and 91.1%, respectively) (both p<0.001). Two patients had "cheese wiring" damage of the lower canaliculus and 1 patient in the TCLDCR group had a full-thickness skin defect in the medial canthal region. No serious intra- or postoperative complication occurred in the EXDCR group. CONCLUSION: Although a TCLDCR procedure decreased the surgical time, it had a significantly lower success rate in the treatment of acquired nasolacrimal duct obstruction compared to EXDCR. The decision of the type of surgery should be made based on the cosmetic and success expectations of the patients and the presence of systemic problems.

Syrian Civil-War-Related Intraocular Foreign Body Injuries: A Four-Year Retrospective Analysis.

PURPOSE: To analyze the data of patients who underwent vitreoretinal surgery due to intraocular foreign body (IOFB) injuries that occurred in the Syrian civil war. METHODS: Seventy-eight eyes of 78 patients who underwent vitreoretinal surgery due to IOFB injuries that occurred during the Syrian civil war were analyzed. RESULTS: Forty-four eyes (56.4%) had traumatic cataract, 44 (56.4%) had retinal tears, 42 (53.8%) had vitreous hemorrhage, 18 (23%) had retinal detachment, 12 (15.3%) had endophthalmitis, and eight eyes had hyphema (10.2%). IOFBs consisted of metal in 62 eyes (79.4%), stone in eight eyes (10.2%), organic material in four eyes (5.1%), and glass in four eyes (5.1%). Approximately 86% of the eyes had initial VAs of 4/200 or worse. However, VAs improved in 64 eyes (82%) after the surgeries. CONCLUSIONS: Despite delays in treatment and the severity of injuries, 82% (64/78) of the eyes had an improvement in VA after the surgeries.

Does the treatment of amblyopia normalise subfoveal choroidal thickness in amblyopic children?

PURPOSE: Recent studies have found a choroidal thickening in amblyopic eyes and suggested that there might be a relationship between the choroid and amblyopia. The present study aimed to evaluate the effect of a six-month treatment of amblyopia on choroidal thickness in anisometropic hyperopic amblyopic children. METHODS: Thirty-two anisometropic hyperopic children with unilateral amblyopia were included in this prospective study. Subfoveal choroidal thickness was measured as the distance between the retinal pigment epithelium and the chorioscleral edge, by using spectral domain enhanced depth imaging optical coherence tomography. The treatment of amblyopia was performed based on the full correction of the refractive error with eyeglasses, a refractive adaptation phase and occlusion by patching the fellow eye. RESULTS: The mean visual acuity of the amblyopic eyes significantly increased from 0.35 ± 0.3 to 0.16 ± 0.2 logMAR after the treatment (p < 0.001). The mean initial choroidal thickness was significantly higher in the amblyopic eyes than in the fellow eyes (p = 0.019). There were no significant differences between the pre- and post-treatment mean choroidal thickness in the amblyopic eyes (p = 0.428) and in the fellow eyes (p = 0.343). The mean choroidal thickness was still higher in the amblyopic eyes than in the fellow eyes after the treatment (p = 0.006). CONCLUSIONS: Although a six-month treatment of amblyopia increased the visual acuity of the anisometropic hyperopic amblyopic eyes, it could not significantly change choroidal thickness. Our results were in accordance with the conventional explanation, which suggests visual cortex and lateral geniculate nucleus abnormalities in the pathophysiology of amblyopia.

Transepithelial High-Intensity Cross-Linking for the Treatment of Progressive Keratoconus: 2-year Outcomes.

PURPOSE: To report 2-year outcomes of transepithelial high-intensity cross-linking (CXL) procedure in the treatment of patients with progressive keratoconus. METHODS: Forty-eight eyes of 48 consecutive progressive keratoconus patients who underwent transepithelial accelerated CXL procedure were enrolled in the study. Each patient underwent pre- and postoperative comprehensive ophthalmologic examinations including determination of refractive error as spherical equivalent (SE) and corrected distant visual acuity (CDVA), slit lamp biomicroscopic examination, fundoscopy, and a detailed analysis on a Scheimplug+Placido device (Sirius, CSO, Florence, Italy). The riboflavin solution, which was composed of riboflavin 0.25% with hydroxypropyl methylcellulose (HPMC) and benzalkonium chloride (BAC) (ParaCel, Avedro), was used in the procedure. The cornea was exposed to ultraviolet A light (KXL System, Avedro Inc., Waltham, MS, USA) for 2 minutes and 40 seconds at an irradiance of 45 mW/cm2. RESULTS: The mean age of the patients was 25.9 ± 4.0 (ranging from 18 to 33) years. No significant changes were observed in the mean CDVA, SE, and topographic indices at year 1 and year 2 visits compared to preoperative examination. The mean corneal thickness at the thinnest point was significantly higher at year 1 and year 2 visits than at preoperative examination (p1 = 0.014 and p2 = 0.017, respectively). No intra- or postoperative complications or adverse reactions were observed. CONCLUSIONS: Transepithelial high-intensity (irradiance of 45 mW/cm2 for 2 minutes and 40 seconds) CXL using 0.25% riboflavin solution was a safe and effective method to halt the progression of keratoconus for a 2-year follow-up period.

Neutrophil-to-Lymphocyte Ratio Increases in Patients With Dry Eye.

PURPOSE: To assess the neutrophil-to-lymphocyte ratio (NLR) as an indicator of inflammation in patients with non-Sjögren dry eye disease. METHODS: Serum NLR and C-reactive protein values were determined in 33 patients with dry eye and in 32 controls. The NLR was calculated by dividing the neutrophil count by the lymphocyte count. RESULTS: Characteristics of the dry eye and control groups were similar. The mean NLR value was 2.8 ± 1.4 (range: 1.1-6.1) in the dry eye group and 1.6 ± 0.7 (range: 0.8-2.8) in the control group (P = 0.002, t test). The mean C-reactive protein value was 0.6 ± 0.7 mg/dL (range: 0-2.3 mg/dL) in the dry eye group and 0.5 ± 0.6 mg/dL (range: 0-1.9 mg/dL) in the control group (P = 0.307, t test). CONCLUSIONS: The NLR values were found to be higher in patients with non-Sjögren dry eye than in controls. This result suggests that non-Sjögren dry eye disease may be associated with systemic inflammation or the NLR values may increase in local inflammatory ocular diseases.

Associations between choroidal thickness, axial length and spherical equivalent in a paediatric population.

BACKGROUND: The aim was to compare the choroidal thickness (ChT) of myopic children's eyes with that of emmetropes to determine whether there are associations between ChT, axial length and spherical equivalent (SE) in a paediatric population. METHODS: A total of 117 eyes of 117 children including 53 myopic eyes (myopic group) and 64 emmetropic eyes (emmetropic group) were enrolled in this cross-sectional comparative study. ChT was analysed by using the HD 5 Line Raster scan protocol of spectral domain enhanced depth imaging optical coherence tomography. Subfoveal ChT was measured manually as the distance between the retinal pigment epithelium and the chorioscleral border and three additional measurements were carried out every 750 µm temporal (T1, T2 and T3) and nasal (N1, N2 and N3) to the fovea. RESULTS: The mean age was 11.7 ± 2.7 years (range five to 17 years) in the myopic group and 10.9 ± 3.4 years (range 5 to 17 years) in the emmetropic group. There were no significant differences between the groups concerning age and sex (both p > 0.05). The myopic eyes had significantly thinner subfoveal, T1, T2, T3, N1, N2, N3 and average choroid than the emmetropic eyes (all p < 0.05). In addition, correlation analyses among all the study subjects showed that all subfoveal, T1, T2, T3, N1, N2, N3 and average ChT had negative correlations with axial length and positive correlations with the SE. CONCLUSION: The present study showed that the myopic children's eyes had significantly thinner subfoveal choroid than the emmetropic control eyes. Further, ChT was negatively correlated with axial length and positively correlated with SE in the population that included myopic and emmetropic children.

A New Surgical Treatment Option for Chronic Total Oculomotor Nerve Palsy: A Modified Technique for Medial Transposition of Split Lateral Rectus Muscle.

PURPOSE: To describe a new surgical modified procedure in patients with chronic total oculomotor nerve palsy and to evaluate the results of this procedure. METHODS: Eight eyes of 6 consecutive patients who underwent strabismus surgery due to chronic total oculomotor nerve palsy were enrolled in the study. The lateral rectus muscle was split into two halves and disinserted from the sclera. The upper half of the muscle was passed under the superior rectus muscle and the inferior half of the muscle was passed under the inferior rectus muscle. The two halves of the muscle were moved to the medial rectus muscle insertion area and were sutured to sclera near the insertion. Additional medial rectus resections were made in the undercorrected patients. RESULTS: The mean age was 21.8 ± 12.1 years (range: 11 to 42 years). Postoperatively, 4 of 6 patients had stable horizontal deviations; 1 had orthophoria, 2 had 10 prism diopters (PD) of exotropia, and 1 had 10 PD of esotropia. However, 2 cases had 25 and 30 PD of undercorrection. Additional medial rectus resections were made in these undercorrected patients and horizontal deviations reduced to 15 and 20 PD of exotropia, respectively. The mean primary position horizontal deviation, which was 74.1 ± 10.2 PD before the surgeries, reduced to 10.8 ± 6.6 PD after the surgeries (P < .001). CONCLUSIONS: The authors described a new and relatively simple modified surgical procedure for the treatment of chronic total ocular nerve palsy and reached satisfactory outcomes. Further studies with larger sample sizes are warranted. [J Pediatr Ophthalmol Strabismus. 2016;53(3):150-154.].

Influence of hyperopia and amblyopia on choroidal thickness in children.

PURPOSE: To compare subfoveal choroidal thicknesses (ChTs) of anisometropic hyperopic amblyopic, hyperopic nonamblyopic, and emmetropic control eyes and to investigate the associations between ChT and ambylopia, spherical equivalent (SE), and axial length in the pediatric population. METHODS: Forty-six hyperopic nonamblyopic (hyperopic group), 33 anisometropic hyperopic amblyopic (amblyopic group), and 42 emmetropic (emmetropic group) eyes were enrolled in this cross-sectional comparative study. Enhanced depth imaging spectral-domain optical coherence tomography was used for quantitative analysis of subfoveal ChT. ChT was quantified manually as the distance between the hyperreflective line corresponding to the retinal pigment epithelium and the chorioscleral interface at the subfoveal area. RESULTS: The mean age was 10.6 ± 3.3 years (range 5-17) in the hyperopic group, 10.7 ± 3.3 years (range 5-17) in the amblyopic group, and 11.2 ± 3.3 years (range 5-17 years) in the emmetropic group (p = 0.627). The hyperopic and amblyopic groups had significantly thicker choroid compared to the emmetropic group (p1 = 0.005 and p2 = 0.006, respectively). However, there was no significant difference between the hyperopic and amblyopic groups concerning subfoveal ChT (p = 0.857). In addition, covariance analysis showed that although SE was independently associated with subfoveal ChT (p = 0.014), amblyopia had no significant independent effect on subfoveal ChT (p = 0.671). Further, subfoveal ChT had weak correlations with the axial length (r = -0.297, p = 0.001) and SE (r = 0.274, p = 0.002). CONCLUSIONS: Hyperopia was associated with subfoveal ChT, whereas amblyopia had no independent significant effect on subfoveal ChT in our study population.

Clinical characteristics and surgical outcomes of pediatric rhegmatogenous retinal detachment.

The objective of this study was to analyze the characteristics and surgical results of pediatric rhegmatogenous retinal detachment (RRD). The medical records of 30 eyes of 29 patients younger than 18 years of age who underwent vitreoretinal surgery due to RRD were analyzed. The gender, age, laterality, duration of presenting symptom, etiology, ocular and systemic co-morbidities, type of breaks, lens status, presence of proliferative vitreoretinopathy (PVR) and its grade, initial and final best-corrected visual acuities (BCVAs), surgical management, number of operations, duration of follow-up, functional and anatomical success, and complications were noted. As the most common predisposing factors were trauma (trauma group) and myopia (myopia group), the data of these patients were further analyzed. The mean age was 12.6 ± 3.0 years. There were 23 male (79.3 %) and 6 female (20.6 %) subjects. The most common etiologic factors were high myopia (40 %) and trauma (36.6 %). Functional success rate was 70 % (n = 21) after the primary surgeries and was 80 % (n = 24) after the secondary surgeries. There were no significant differences between the trauma and myopia groups regarding the presence of total retinal detachment, macula-off status, and the rate of PVR worse than grade C. Although the preoperative mean BCVA and the initial and final retinal reattachment rates of the groups were statistically similar, trauma group had significantly higher postoperative mean BCVA compared to myopia group (p = 0.013). Myopia and trauma were the most common etiologic factors for RRD in children. The visual outcomes of trauma-associated RRD were better than those of myopia-associated RRD.

Influence of Pterygium on Corneal Biomechanical Properties.

PURPOSE: To evaluate the influence of pterygium on corneal biomechanical properties as measured by the ocular response analyzer (ORA). METHODS: ORA measurements of 48 eyes with primary nasal pterygium were compared with those of healthy fellow eyes. The mean age of the patients was 46.6 ± 18.9 years. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc) were obtained for each subject by using the ORA (Reichert Ophthalmic Instruments, Depew, NY). RESULTS: CH and CRF were significantly lower in the eyes with pterygium than in the healthy fellow eyes (p1 = 0.011, p2 = 0.014, respectively). On the other hand, there were no significant differences between the eyes with pterygium and healthy fellow eyes concerning IOPg and IOPcc (p1 = 0.948, p2 = 0.129, respectively). CONCLUSIONS: The present study showed that biomechanical properties measured by ORA were affected by pterygium. The eyes with primary nasal pterygium had lower CH and CRF than healthy fellow eyes. Therefore, the effect of pterygium should be taken into account in order to make correct diagnoses by ORA.

Influence of indoor and outdoor activities on progression of myopia during puberty.

The purpose of this study was to investigate whether time spent on indoor and outdoor activities or the other possible risk factors including age, gender, parental history, and initial refraction was associated with progression of myopia, during puberty. Fifty eyes of 50 myopic children aged 9-14 years were enrolled in the study. The parents were interviewed to determine the amounts of time in hours per day spent on reading and writing, using computer, watching TV, and outdoor activities (i.e., sports, games, or being outdoor with no activities) on an average day. The annual myopia progression rate (diopters per year) was calculated for each subject and was used in the statistical analyses. The mean initial age of the subjects was 10.9 ± 1.5 (ranging from 9 to 14) years. The mean follow-up period was 33.3 ± 10.3 (ranging from 17 to 55) months. There was a significant increase in the mean myopia value of the subjects after follow-up period (p < 0.001). The mean daily time spent on reading and writing and initial refraction value were independently associated with annual myopic progression rate. On the other hand, age, gender, parental myopia, and the mean daily times spent on computer use, watching TV, and outdoor activities had no correlations with annual myopia progression rate. The present study showed that myopia progression was associated with time spent on reading and writing and initial refraction value, during puberty. However, myopia progression was not associated with parental myopia, age, gender, and daily times spent on using computer, watching TV, and outdoor activities.

Intravitreal Dexamethasone Implant for Treatment of Refractory Behçet Posterior Uveitis: One-year Follow-up Results.

PURPOSE: To investigate the results of dexamethasone (DEX) implant in the treatment of eyes with refractory Behçet posterior uveitis. METHODS: A total of 17 eyes of 12 patients with active Behçet posterior uveitis were enrolled in the study. A single intravitreal injection of DEX implant was applied to each eye. Best corrected visual acuity (BCVA), central macular thickness (CMT), vitreous haze score, and intraocular pressure (IOP) were determined, at baseline and control visits of months 1, 3, 6, and 12. RESULTS: The mean BCVA was significantly increased from baseline at each control visit (all p < 0.05). The mean CMT and vitreous haze score were significantly decreased from baseline at each control visit (all p < 0.05). Three eyes showed IOP spikes requiring topical anti-glaucomatous treatment. CONCLUSIONS: A single injection of DEX implant was safe and effective, as an additional treatment to systemic immunomodulatory drugs, in the treatment of refractory Behçet posterior uveitis, for a 6-month period.

Using liquid crystal glasses to treat ambyopia in children.

PURPOSE: To evaluate the effectiveness of liquid crystal glasses (LCG) in the treatment of children with monocular amblyopia. METHODS: A total of 14 amblyopic eyes of 14 children with monocular amblyopia were enrolled in the study. LCG with appropriate refractive correction were ordered for each patient. Each patient was examined with the new LCG before treatment and monthly thereafter. The parents were informed about the use, care, and charging of the glasses. Best-corrected visual acuity was measured as Snellen decimal notation and converted to logarithm of the minimum angle of resolution (logMAR) for statistical analyses. RESULTS: The mean age of the study population was 7.4 ± 1.4 years. Ten patients (71%) had anisometropic amblyopia; 2 (14%), strabismic amblyopia; and 2 (14%), mixed amblyopia. The mean follow-up period was 4.0 ± 1.2 months (range, 3-7 months). The mean duration of using LCG was 8.2 ± 2.5 hours daily (range, 4-12 hours). All of 14 patients used the LCG as suggested. The mean logMAR best-corrected visual acuity of the amblyopic eyes was 0.6 ± 0.3 at baseline, improving to 0.3 ± 0.2 at final follow-up (P < 0.001). No side effects were observed. CONCLUSIONS: The current study demonstrated that LCG wear improved visual acuity in children with monocular amblyopia. Additional studies are needed to determine whether this effect is due to the LCG on/off feature or to refractive correction alone.

Effect of pathological myopia on biomechanical properties: a study by ocular response analyzer.

AIM: To evaluate the ocular response analyzer (ORA) measurements of patients with pathological myopia in comparison with those of emmetropic control subjects, and to investigate the correlation between these ORA measurements and spherical equivalent (SE). METHODS: Measurements of 53 eyes of 53 subjects with pathological myopia (SE>-6.00 D) were compared with those of 60 eyes of 60 emmetropic controls. Corneal hysteresis (CH), corneal resistance factor (CRF), noncontact tonometer intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc) were obtained for each subject. The refractive error value was determined as SE via a cycloplegic refraction test. RESULTS: The mean age was 54.1±18.9y (ranging from 5 to 88) in the pathological myopic group and 56.2±19.0y (ranging from 6 to 89) in the control group. There were no significant differences between the groups concerning age and sex. CH and CRF were significantly lower in the pathological myopic group than in the control group (P<0.001, P=0.005, respectively). IOPcc and IOPg were significantly higher in the pathological myopic group than in the control group (P<0.001, P=0.009, respectively). There were significantly positive correlations between CH and SE (r=0.565, P<0.001) and between CRF and SE (r=0.364, P=0.007). There were significantly negative correlations between IOPcc and SE (r=-0.432, P=0.001) and between IOPg and SE (r=-0.401, P=0.003). CONCLUSION: The present study displayed that pathological myopia affected biomechanical properties measured by ORA. The results of corneal biomechanical properties measured by ORA may need to be appreciated by taking refraction into account. Further, pathological myopia might be related with the increased IOP.

Association between penetrating eye injuries and attention deficit hyperactivity disorder in children.

PURPOSE: To investigate whether there is an association between penetrating eye injuries and attention deficit hyperactivity disorder (ADHD) symptoms in children. METHODS: 45 children aged 3-18 years who were treated due to penetrating ocular injuries (patient group) and 75 control subjects (control group) were enrolled in the study. The symptoms of ADHD were evaluated by the Turkish adapted and validated form of the Conner Parent Rating Scale (CPRS). RESULTS: The mean age was 8.9±4.1 years in the patient group and 9.7±3.7 years in the control group. All subscale scores of CPRS were higher in the patient group compared with the control group (all p<0.05). Gender-specific analyses showed that the boys of the patient group had significantly higher mean scores of all subscales, including inattentiveness, hyperactivity, oppositional defiant disorder and conduct disorder, compared with the boys of the control group (all p<0.05). However, the girls of the patient group had higher mean scores of only the conduct disorder subscale (p<0.05) compared with the girls of the control group. Three of 45 patients (6.6%) and 0 of 75 control subjects (0%) had a history of previous ocular trauma (p<0.05). CONCLUSIONS: There was an association between penetrating eye injuries and inattentiveness, hyperactivity, oppositional defiant disorder and conduct disorder in boys, and conduct disorder in girls. An appropriate evaluation of ADHD symptoms may prevent vision loss due to penetrating eye injuries in children. In addition, evaluation by a child psychiatrist of children presenting with penetrating eye injuries may prevent repetition of injuries.

Follow up of retinal nerve fiber layer thickness with optic coherence tomography in patients receiving anti-tubercular treatment may reveal early optic neuropathy.

PURPOSE: To evaluate the effect of anti-tubercular treatment on retinal nerve fiber layer (RNFL) thickness and the efficiency of optic coherence tomography (OCT) on early diagnosis of optic neuropathy. METHODS: Twenty patients diagnosed with either pulmonary or extra-pulmonary tuberculosis which were treated with anti-tubercular treatment (isoniazid (INH), rifampicin, ethambutol (ETM), and pyrazinamide) were enrolled in the study. RNFL thicknesses of the patients were measured via OCT, at baseline (before starting anti-tubercular treatment) and after the two-month treatment period. Standard ophthalmologic examinations were also performed. RESULTS: Compared to baseline values, after the two-month treatment period, thinning was detected in the right eye's average and superior quadrant RNFLs (p = 0.024 and p = 0.006 respectively) and in the left eye's average, superior quadrant, and inferior quadrant RNFLs (p = 0.001, p = 0.008, p < 0.001, respectively). CONCLUSION: We displayed that patients receiving INH and ETM, which were the basic medicines of anti-tubercular treatment, experienced thinning in RNFL after the two-month treatment period. Patients receiving these drugs can be followed via OCT in terms of reduction in RNFL thicknesses for early diagnose of INH and ETM toxicity.

Systemic arterial stiffness in patients with pseudoexfoliation glaucoma.

AIM: : To evaluate carotid-femoral pulse wave velocity (CF-PWV) values of patients with pseudoexfoliation (PEX) glaucoma in comparison with healthy subjects. METHODS: Twenty-five consecutive patients with PEX glaucoma (PEXG group) and 25 controls (control group) were included in the study. CF-PWV was assessed by a noninvasive device by the measurements of pulse transmit time and the distance between 2 recording sites. RESULTS: The mean age was 64.7±7.3 (range, 55 to 79) years the in PEXG group and 63.8±6.6 (range, 51 to 77) years in the control group. There were 8 men (32%) and 17 women (68%) in the PEXG group and 11 men (44%) and 14 women (56%) in the control group. The CF-PWV of the PEX group was significantly higher than that of the control group (P<0.001). CONCLUSIONS: We have revealed an association between PEXG and increased CF-PWV. Also, increased CF-PWV may be considered as a risk factor for the development of PEXG.

Effect of axial length on retinal nerve fiber layer thickness in children.

PURPOSE: To investigate the effect of axial length on peripapillary retinal nerve fiber layer (RNFL) thickness in myopic, hyperopic, and emmetropic eyes in children by Cirrus HD spectral-domain optical coherence tomography (OCT). METHODS: Subjects were divided into 3 groups according to their refractive status: myopic (n = 36), emmetropic (n = 30), and hyperopic (n = 28) eyes. The RNFL thickness measurements were taken from the superior, inferior, nasal, and temporal quadrants in the peripapillary region by Cirrus HD OCT. Axial length was also determined for each patient. RESULTS: The myopic eyes had thinner average RNFL and RNFLs of temporal, superior, nasal, and inferior quadrants than the hyperopic eyes (p1<0.001, p2 = 0.004, p3 = 0.011, p4 = 0.006, p5 = 0.033, respectively). In addition, average peripapillary RNFL thickness and RNFL thicknesses of all quadrants had significant negative correlations with axial length. On the other hand, after applying modified Littmann formula for correction of magnification effect, the differences among the 3 groups disappeared (all p>0.05). CONCLUSIONS: We have shown that axial length and accordingly refractive status influenced peripapillary RNFL thickness measurements by Cirrus HD OCT in children. Therefore, to make a correct diagnosis of glaucoma or other optic neuropathies in children, either axial length-induced magnification effect should be corrected by ophthalmologists or the current Cirrus HD OCT database should be revised taking axial length into consideration.