Evaluation of maternal attachment, self-efficacy, levels of depression, and anxiety in mothers who have babies diagnosed with retinopathy of prematurity.

PURPOSE: The aim of this study is to evaluate the emotional stress and its effects on parental self-efficacy and mother-infant attachment in mothers whose babies were diagnosed with retinopathy of prematurity (ROP). METHODS: Study sample was consisted of voluntarily participating 82 mothers whose babies were first diagnosed with ROP, 83 mothers of preterm babies without ROP, and 85 mothers of term babies admitting for their routine visits. Sociodemographic data form maternal attachment scale, state-trait anxiety inventory, Edinburgh postnatal depression scale, and parental self-efficacy scale were applied to study participants, and the overall results of three groups were statistically compared. RESULTS: The sociodemographic features of three study groups were similar. Statistical significant differences were found in depression and state anxiety levels among study groups, while maternal attachment scale and trait anxiety level scores and parental self-efficacy scale total score were similar in study groups. Maternal depression and state-anxiety levels were tend to be higher in mother of children diagnosed with ROP and prematurity; however, there were no statistically significant differences between levels of mothers' of premature children with or without ROP. CONCLUSION: This is the first study in literature assessing the additional effect of ROP on the anxiety and depression levels of recent mothers, as well as mother-infant attachment and parental self-efficacy. Supporting of mothers having an infant with diagnosed ROP is crucial because of feeling themselves inefficient and responsible for all interventions applied to their babies.

Changing trends over the last decade in the aetiology of childhood blindness: a study from a tertiary referral centre.

AIMS: To discern treatable and preventable causes of childhood blindness by evaluating the aetiologic factors, and to compare the distribution of the most commonly affected anatomic sites of severe visual impairment (SVI) with our previous published data. METHODS: The charts of 11 871 patients followed between June 2002 and May 2014 were reviewed retrospectively, and 695 patients (5.9%) who had SVI or blindness in accordance with WHO criteria were enrolled. The results of ophthalmologic examinations and coexistence of any systemic disease were documented and checked against our published clinic data concerning the aetiology of childhood blindness before 2002. χ(2) test was used for statistics. RESULTS: Mean age was 47.0±51.9 months (median: 24 months). Cortical visual impairment (CVI) was present in 212 cases (30.5%) and 20.3% of those had a history of premature birth. The most common anatomic sites of SVI were retina (24.6%) and crystalline lens (17.1%). When compared with our previous data, we found a significant increase in the prevalence of CVI (p=0.046) and decrease in the frequency of SVI due to uveal disorders (p<0.001). Prevalence of blindness secondary to retinopathy of prematurity reduced by a third (p=0.280), and a significant decrease in aphakia-related SVI (p=0.028) was achieved within the last decade. CONCLUSIONS: The prevalence of CVI was found to be relatively increased due to the significant reduction in the frequency of preventable causes of SVI. Furthermore our clinical practice for visual rehabilitation in aphakia has resulted in a considerable decrease in SVI in the last decade.

Ocular disorders in children with spastic subtype of cerebral palsy.

AIM: To document common ocular abnormalities in children with spastic subtype of cerebral palsy (CP) and to find out whether any correlation exists between their occurance and etiologic factors. METHODS: Totally 194 patients with the diagnosis of spastic type CP were enrolled in this retrospective study. Detailed ophthalmic examinations were performed. Demographic data and neuroradiological findings were documented. Kruskal-Wallis, Mann Whitney U, Pearson Chi-square tests and Student's t tests were used in the statistical analysis. RESULTS: The mean age was 64.7±44.2 months on the first ophthalmic examination. Prevalences of diplegia (47.4%) and tetraplegia (36.1%) were found to be higher than the frequency of hemiplegia (16.5%) in our study population. Etiologic factor was asphyxia in 60.8% of the patients. Abnormal ocular findings were present in 78.9% of the patients. Statistically significant poor vision was detected in tetraplegia group among all the spastic ubtypes of CP (P=0.000). Anisometropia and significant refractive error were found in 14.4% and 70.1% of the patients, respectively. Thirty-six children (18.6%) had nystagmus and 107 children (55.2%) had strabismus. Lower gestational age and birth weight were statistically higher in patients with esotropia than exotropia (P=0.009 and P=0.024, respectively). Abnormal morphology of the optic disc was present in 152 eyes (39.2%). Severe periventricular leukomalacia (PVL) was found in 48 patients and statistically significant poor vision was detected in the presence of PVL (P=0.000). CONCLUSION: Spastic diplegic or tetraplegic CP patients with positive neuroradiological symptoms, younger gestational age and lower birth weight ought to have detailed ophthalmic examinations as early as possible to provide best visual rehabilitation.

Efficacy of occlusion treatment in amblyopia and clinical risk factors affecting the results of treatment.

PURPOSE: To evaluate the factors influencing visual outcome in strabismic, strabismic-anisometropic and anisometropic amblyopia following occlusion treatment. METHODS: Records of 128 pediatric patients who had been treated for amblyopia by occlusion of the fellow eye between March 1992 and March 2003 were reviewed retrospectively. Age and level of visual acuity at initiation of treatment, occlusion time (full-time, part-time or minimal) and type of amblyopia were analyzed for the effect on visual outcome. RESULTS: The mean age of the patients was 5.69 +/- 2.01 years (3 to 12 years). Mean follow-up time was 3 years 2 months (6 months to 10 years). Mean visual acuity improvements were similar for the subtypes of amblyopia (strabismic amblyopia 0.38 +/- 0.29 logMAR units, strabismic-anisometropic amblyopia 0.46 +/- 0.40 logMAR units, anisometropic amblyopia 0.35 +/- 0.24 logMAR units). Level of initial visual acuity, age at initiation of treatment and type of occlusion correlated with the final visual acuity (p = 0.000, p = 0.035, p = 0.012, respectively). When the analysis was performed according to the subtypes of amblyopia, initial visual acuity was the only factor associated with the final visual acuity in all types of amblyopia (p < 0.05). CONCLUSION: The level of initial visual acuity is the most significant factor determining the success of treatment in amblyopia.

Psychosocial aspects of mothers of children with strabismus.

PURPOSE: The aim of the study was to investigate the psychological profile of mothers of children with strabismus, their attitudes to their children, and their family functioning. METHODS: This study was conducted at Dokuz Eylül University School of Medicine, from 2000 to 2002 and involved a series of 30 children with strabismus and 31 healthy controls. All mothers were asked to complete Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Parental Attitude Research Instrument (PARI), and Family Assessment Device (FAD). RESULTS: Mothers of the children with strabismus had significantly higher depression scores ( P = 0.042) compared with mothers of the control group. They demonstrated significantly lower scores in democratic attitude, meaning that they failed to constitute a supportive and friendship relation with their children, ( P = 0.0001). These mothers had significantly higher scores in rejection of maternal role ( P = 0.017) as compared with mothers of the control group. They were nervous, distressed, and angry in the relationship with their children, with unhappiness and more dissatisfaction with respect to maternal role. Mothers of the children with strabismus had poor role functioning in the family, which is related to satisfying the food, clothing, and support needs ( P = 0.034). They also had poor affective responsiveness, which means the ability of family members to respond with appropriate emotion ( P = 0.003), and poor general functioning ( P = 0.040) as compared with mothers of the control group. CONCLUSIONS: This study demonstrated that, for mothers who have children with strabismus, strabismus had an adverse effect on their lives, and their family relationships.

Treatment outcomes in refractive accommodative esotropia.

PURPOSE: To document and compare the clinical features and functional outcomes in patients with accommodative esotropia. To assess the efficacy of conventional management of accommodative esotropia, to determine functional outcomes of amblyopia and binocular vision, and to analyze possible risk factors involving the development of amblyopia. METHODS: We retrospectively reviewed the charts of 147 patients whose esotropia was corrected to within 10 prism diopters of orthotropia at both distance and near with use of full cycloplegic hyperopic correction. Multiple parameters were reviewed, including initial and final cycloplegic refraction, distance, and near deviation with and without glasses, stereoacuity, age of onset, and initiation of treatment, presence of anisometropia, and change in hyperopia. RESULTS: At presentation, 87 (59.2%) of the 147 patients were amblyopic, and anisometropia was found to be the only statistically significant risk factor for this (P = .001). Only 24.2% of these patients have stereo acuity between 40 and 100 sec/arc, 20.96% of patients have 200 to 800 sec/arc, and 22.58% of patients have 1980 to 3000 sec/arc; the remaining 32.26% had no stereo acuity. Fusion was achieved in 73.5% of the patients and later presentation (> 24 months) of esodeviation significantly determined their fusional ability (P = .031). Consecutive exotropia developed in 5.4 % of the patients an average of 5.5 years after institution of full optical correction. For clinical and functional outcomes we did not find any statistically significant difference between early onset (before 1 year old) and typical onset (2 to 3 years) age groups. The trend towards decreasing hyperopia was apparent, averaging -0.16 +/- 0.20 diopters annually in 80.5% of the patients with at least 5 years follow-up, although 23% of patients still had 20/40 or worse visual acuity in the amblyopic eye. CONCLUSIONS: Amblyopia is a commonly associated finding at presentation for patients with accommodative esotropia. Most of the patients developed good fusion but poor stereopsis at the end of treatment.

Ocular and systemic findings associated with optic disc colobomas.

PURPOSE: To determine the ocular and systemic anomalies associated with optic disc colobomas. PATIENTS AND METHODS: The records of patients with a diagnosis of isolated optic disc coloboma and chorioretinal coloboma with optic disc involvement were retrospectively reviewed. RESULTS: Fifteen patients were included in the study. Of the 30 eyes, the optic disc and choroid were involved in 18, an isolated disc coloboma was present in 5, a normal optic disc was present in 4, and the optic disc could not be identified because of extreme microphthalmia in 1. Of the optic discs outside the fundus colobomas, 1 had an abnormal shape and 1 had optic atrophy and hypoplasia. Eight patients had bilateral but asymmetric involvement of the optic nerve with the coloboma. Fourteen eyes of 9 patients were microphthalmic. Nine eyes of 6 patients had microcornea. One patient had a nonrhegmatogenous retinal detachment at the time of diagnosis. One eye had a retrobulbar cyst with microphthalmia. Eight (53%) of the patients had sensory strabismus. Two patients had unilateral cortical lens opacities. Associated systemic findings were present in 6 (40%) of the 15 patients. CONCLUSIONS: Optic disc colobomas have a wide variety of presentations. Poor visual acuity was observed mostly in eyes with macular involvement and microphthalmia.