Systemic Inflammatory Marker Levels in Serous Macular Detachment Secondary to Retinal Vein Occlusion.

Purpose: To evaluate the association of systemic inflammatory marker levels in macular edema with serous macular detachment (SMD) secondary to retinal vein occlusion (RVO). Methods: Patients diagnosed with RVO were categorized into two groups based on the presence or absence of SMD: Group 1 included 30 eyes with SMD, while Group 2 included 30 eyes without SMD. Levels of neutrophils, monocytes, lymphocytes, thrombocytes, and mean platelet volume (MPV) were analyzed. Systemic inflammatory markers, including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were calculated and compared between the two groups. Results: The mean neutrophil levels were significantly higher in Group 1 (P = 0.002). The mean lymphocyte, monocytes, thrombocyte, and MPV levels did not differ significantly between groups. NLR and SII levels were significantly higher in the SMD group (P = 0.004 and P = 0.016, respectively). There was no significant difference between the groups in terms of PLR. The optimal receiver operator characteristic (ROC) cut-off value of NLR for SMD was calculated as 1.55 with 73% sensitivity and 63% specificity (area under the curve [AUC] = 0.714, 95% confidence interval [CI]: 0.584-0.845). The optimal ROC cut-off value of SII for SMD was calculated as 451.75 with 63% sensitivity and 63% specificity (AUC = 0.681, 95% CI: 0.546-0.816). In this study, branch RVO was present in 48 patients, and central RVO was present in 12 patients. Neutrophil, MPV levels, and NLR, PLR, SII ratios were similar between patients with branch and central occlusion. Conclusion: Neutrophil levels, NLR, and SII were found to be significantly higher in eyes with SMD secondary to RVO.

Non-ocular risk factors in Turkish children with strabismus and amblyopia.

BACKGROUND: To evaluate non-ocular risk factors including family history, febrile seizure, history of trauma, neurological diseases, and prematurity in Turkish children with strabismus and amblyopia. METHODS: The records of patients diagnosed with strabismus and/or amblyopia below 18 years old, were recruited. The current mean age, sex, types and subtypes of strabismus and amblyopia, family history, history of trauma, and febrile seizure were investigated. The presence of neurological diseases and prematurity were noted. Family history was investigated whether the presence of strabismus or amblyopia was maternal or paternal. Blood relatives were divided into 3 groups including first, second, and third-degree relatives. The relationship between blood relative degrees and types of strabismus or amblyopia were assessed. RESULTS: There were 803 patients with a current median age of 8 years (1-29 years). Of these patients, 786 patients could be evaluated and 55% had esotropia (ET), 32.6% had exotropia (XT) and 12.5% had amblyopia as a primary diagnosis. Positive family history of strabismus or amblyopia was more common among all risk factors. There was a statistically significant rate of patients with a positive family history in the first-degree relatives, in the esotropic patient group (p= 0.002). Maternal positive family history was more common in patients with refractive ET (p= 0.024) and paternal positive family history was more common in patients with intermittent XT (p= 0.009). CONCLUSIONS: The rates of positive family history of amblyopia and strabismus were not statistically different. Family history of strabismus in first-degree relatives of patients with esotropia was markedly high. The family history of strabismus on the maternal or paternal side might be different in patients with different subtypes of strabismus.

The effect of amblyopia on clinical outcomes of children with astigmatism.

BACKGROUND: Amblyopia is more common in children with high astigmatism, but factors contributing to development of amblyopia and visual outcomes are not fully understood. OBJECTIVE: To evaluate the effect of amblyopia on the clinical outcomes in children with ⩾1.75 diopter (D) astigmatism. METHODS: We reviewed the medical records of children with ⩾1.75 D astigmatism with and without amblyopia (amblyopes group and non-amblyopes group). The mean age, gender, amount and type of ocular deviation, presence of convergence insufficiency (CI), stereopsis, time of initial spectacle use and follow-up time, differences in best-corrected visual acuity (VoD) and spherical equivalent (SE) between eyes were assessed and compared between the groups. Best-corrected visual acuity (BCVA), mean SE, astigmatism measurements were assessed and compared between amblyopic, fellow, and non-amblyopic eyes. RESULTS: The records included 68 eyes of 34 children with amblyopia and 56 eyes of 28 children without amblyopia. The mean age, gender, amount and type of ocular deviation, presence of CI, stereopsis, time of initial spectacle use, follow-up time, and the difference in SE did not differ between groups. In amblyopes, exodeviation was more common and statistically greater in near (33 cm) than at distance (6 m) (p = 0.005). The mean BCVA and astigmatism values were statistically different between amblyopic, fellow, and non-amblyopic eyes. CONCLUSION: A greater near than distance exodeviation and higher mean astigmatism value were found in amblyopic children with astigmatism.

Optical coherence tomography measurements in patients with systemic hypertension.

AIM: To evaluate the effect of systemic arterial hypertension (SAH) on retinal optical coherence tomography (OCT) parameters and investigate whether a correlation exists between ambulatory blood pressure monitoring (ABPM) and OCT measurements.Material-methods: 115 SAH patients (225 eyes) and 123 healthy control cases (234 eyes) were included. ABPM was performed on 89 of 115 SAH patients. All patients underwent detailed ophthalmologic examination including imaging with OCT. SAH patients were divided into two groups (dippers, non-dippers) according to their nocturnal blood pressure (BP) reduction, and OCT measurements were compared. RESULTS: Average and superior retinal nerve fiber layer (RNFL) quadrants were significantly thin in hypertensive cases (p:0.002, p < 0.001, respectively). Cup area, cup/disk (c/d) area, and c/d horizontal ratios were wider; the rim area was smaller in hypertensive cases (respectively: p:0.024, p:0.017, p:0.003, p < 0.001). Total macular volume (TMV), the thicknesses in 1-3 and 1-6 mm of the macula were less in hypertensives (p < 0.001). There was no significant difference between dippers and non-dippers in RNFL thickness, macula and optic nerve head (ONH) parameters. CONCLUSION: There were statistically significant differences between healthy cases and patients with SAH in terms of RNFL, macula thicknesses and ONH parameters.

Strong fixation preference in patients with manifest exotropia: Does it matter or not?

PURPOSE: To evaluate the influence of strong fixation preference on clinical and surgical outcomes, in non-amblyopic patients with basic-type intermittent exotropia (IXT). MATERIALS AND METHODS: The records of patients were retrospectively investigated. Non-amblyopic patients with the diagnosis of basic-type IXT were enrolled and divided into two groups according to the presence of strong fixation preference (SFP). Best-corrected visual acuity, refractive errors, deviations in near and distance, convergence patterns, motor fusion, stereopsis were evaluated and compared. Patients who underwent surgery in each group composed subgroups and postoperative deviations, convergence patterns, motor fusion, and stereopsis were compared. RESULTS: Seventy-seven patients were enrolled and divided into two groups according to the presence of SFP: patients with SFP composed Group 1 and patients with alternating fixation composed Group 2. Statistically significant difference was seen between groups in terms of motor fusion (p: 0.02). Other parameters did not differ between groups. Data obtained from patients in subgroups of each group were not statistically different. CONCLUSION: The evaluation of basic-type exotropic patients according to their fixation preference revealed us that motor fusion might be affected by strong fixation preference. We also observed that SFP did not affect surgical success rates, convergence patterns, and stereopsis of exotropic patients.

Corneal topography, anterior segment and high-order aberration assessments in children with ≥ 2 diopter astigmatism.

PURPOSE: To assess topographic findings, anterior segment parameters and high-order aberrations (HOAs) by using corneal tomography in children with 2 diopters (dp) or more astigmatism. METHODS: Children with 2 dp or more astigmatism (study group) and children with astigmatism less than 1 dp (control group) were recruited. Corneal astigmatism, mean, steep, flat keratometry (K) findings, anterior and posterior K results and anterior segment parameters including anterior chamber depth, kappa distance, horizontal corneal diameter, mean, central, middle, peripheral corneal thicknesses (CT), white-to-white (WTW) distance and pupil diameter were measured by Galilei G4 Dual Scheimpflug corneal tomography. HOAs were also assessed and compared between groups. RESULTS: Fifty-eight eyes of 37 children in the study group and 37 eyes of 37 children in the control group were enrolled. The mean ages of groups were 9.7 ± 2.4 years and 9.3 ± 1.6 years in study and control groups, respectively. The mean astigmatism was 3.3 ± 1.1 dp and 0.5 ± 0.3 dp in study and control groups, respectively (p < 0.05). Total corneal astigmatism was 3.3 ± 0.84 dp and 1.14 ± 0.47 dp in study and control groups, respectively (p < 0.05). There was a significant difference between groups in terms of posterior steep K and posterior astigmatism values. Among anterior segment parameters, mean CT and WTW values were statistically different between groups. HOAs were found to be statistically different between groups. CONCLUSION: Higher posterior corneal astigmatism, thinner mean CT and lower WTW distance were found in children with 2 dp or more astigmatism. Besides, HOAs were much more in these astigmatic children.

Factors influencing stereopsis in patients with both refractive accommodative esotropia and amblyopia.

PURPOSE: Potential factors influencing stereopsis were investigated in patients with both refractive accommodative esotropia (RAE) and amblyopia. MATERIALS AND METHODS: A retrospective chart review was performed to find out all patients with the diagnosis of both RAE and amblyopia. Patients are classified into two groups: group 1 (with stereopsis) and group 2 (without stereopsis). Onset age of RAE, history of strabismus in family members, time of amblyopia treatment, mean spherical equivalent, anisometropia, ocular movement disorders, especially, overaction of inferior oblique (IO) muscle, visual acuity difference (VAD) between eyes, best-corrected visual acuity (BCVA) levels of amblyopic and normal eyes and the presence of alternation of fixation (AOF) were investigated as possible factors. These factors were compared statistically between groups. RESULTS: Groups 1 and 2 consisted of 21 and 26 patients, respectively. There was no statistical significant difference in terms of onset age of RAE, family history, amblyopia treatment, BCVA of normal eyes and anisometropia. IO overaction and higher VAD were found to be statistically different between groups (p: 0.019, p: 0.022, respectively). Besides, there was significant difference in terms of AOF and better BCVA in amblyopic eyes (p: 0.000, p: 0.009, respectively). CONCLUSION: IO overaction, BCVA in amblyopic eyes, VAD and AOF were found to be potential risk factors for the development of stereopsis in patients with both RAE and amblyopia.

Toxic anterior segment syndrome after uncomplicated cataract surgery possibly associated with intracamaral use of cefuroxime.

PURPOSE: To report toxic anterior segment syndrome (TASS) after cataract surgery possibly associated with intracameral use of cefuroxime. METHODS: We conducted a retrospective chart review and analysis on the pre- and postoperative conditions of the subjects who had developed TASS. RESULTS: The patient group consisted of 17 patients. Tyndallization and fibrin fibers were positive in all eyes. In four eyes, hypopyon formation developed. These reactions diminished on the third day and fully resolved 1 week after the operations with the use of intensive topical steroid and mydriatic therapy. To determine the etiology of TASS, infusion fluid, viscoelastics, and intracameral antibiotic agent were changed respectively. After changing intracameral antibiotic agent from cefuroxime axetile to moxifloxacin no new cases of TASS were diagnosed. CONCLUSION: All agents injected into the anterior chamber can cause TASS. Ophthalmologists and operating room staff need to pay careful attention to all drugs and irrigating solutions.

Changes in vision related quality of life in patients with diabetic macular edema: ranibizumab or laser treatment?

PURPOSE: To compare the changes in vision related quality of life (VR-QoL) in patients with diabetic macular edema (DME) undergoing intravitreal ranibizumab (IVR) injection or focal/grid laser. MATERIAL AND METHODS: In this prospective study, 70 patients with clinically significant macular edema (CSME) were randomized to undergo IVR injection (n=35) and focal/grid laser (n=35). If necessary, the laser or ranibizumab injections were repeated. Distance and near visual acuities, central retinal thickness (CRT) and The 25-item Visual Function Questionnaire (VFQ-25) were used to measure the effectiveness of treatments and VR-QoL before and after 6 months following IVR or laser treatment. RESULTS: The demographic and clinical findings before the treatments were similar in both main groups. The improvements in distance and near visual acuities were higher in IVR group than the laser group (p<0.01). The reduction in CRT in IVR group was higher than that in laser treatment group (p<0.01). In both groups, the VFQ-25 composite score tended to improve from baseline to 6 months. And at 6th month, the changes in composite score were significantly higher in IVR group than in laser group (p<0.05). The improvements in overall composite scores were 6.3 points for the IVR group compared with 3.0 points in the laser group. Patients treated with IVR and laser had large improvements in composite scores, general vision, near and distance visual acuities in VFQ-25 at 6 months, in comparison with baseline scores, and also mental health subscale in IVR group. CONCLUSION: Our study revealed that IVR improved not only visual acuity or CRT, but also vision related quality of life more than laser treatment in DME. And these patient-reported outcomes may play an important role in the treatment choice in DME for clinicians.