The Repeatability, Reproducibility, and Correlation of the Schirmer Test: A Comparison of Open versus Closed Eye.

PURPOSE: To compare the repeatability and reproducibility of the Schirmer test (ST) without anesthesia when the eyes are open (STo) and closed (STc) in previously undiagnosed patients with suggestive symptoms of dry eye. METHODS: In a comparative, observational series case study, 31 patients were included in the study. STo and STc were alternately applied for a total of six times. The ST was applied two times with the eyes open (S1) and closed (S2), respectively, by a single ophthalmologist. Then the ST was repeated four times with the eyes open (S3, S5) and closed (S4, S6), respectively, by a single nurse. RESULTS: S1, S3, and S5 were 23.4, 23.7, and 23.3 mm, respectively. S2, S4, and S6 were 14.7, 15.6, and 16.6 mm, respectively. STc scores were found to be statistically lower than the STo's in general (right: t = 2.033, p = 0.048; left: t = 3.474, p = 0.004). There was no statistically significant difference in the scores of the three tests with open eyes: S1, S3, and S5 (p = 0.462). There was also no statistically significant difference in the scores of the three tests with closed eyes: S2, S4, and S6 (p = 0.05). CONCLUSIONS: Our study suggests that although administering the ST with the patient's eyes open produces higher readings than STc in patients with suggestive symptoms of dry eye, there was an acceptable reliability among tests performed open and closed. Moreover, intraexaminer reliability was higher than interexaminer reliability for both with the eyes open and closed.

Relationship Between the Clinical Factors and Deviation Control in Intermittent Exotropia.

PURPOSE: To establish whether clinical factors were correlated with deviation control in intermittent exotropia. METHODS: This retrospective study included 54 patients with intermittent exotropia. The patient's sex, family history, age at first admission, best corrected visual acuity, refractive errors after cycloplegia, angles of ocular deviation at near and distance, and near, distance, and total deviation control were evaluated. Ocular deviation controls were determined according to the Mayo Clinic's office-based scale. Correlation analysis was performed between the deviation control and the determined clinical factors. RESULTS: Spearman correlation analyses revealed a mild correlation between age with total exotropia control score and age with the control of near exotropia control score (r = 0.320, P = .018 and r = 0.339, P = .012, respectively). The angle of deviation at near showed a significant moderate correlation between total exotropia control score and near exotropia control score (r = 0.523, P < .001 and r = 0.780, P < .001, respectively). The deviation angle at distance showed a mild correlation with distance exotropia control score and total exotropia control score (r = 0.423, P = .001 and r = 0.288, P = .034, respectively). The angle of deviation at distance showed a mild correlation with the angle of deviation at near (r = 0.359, P = .008). The deviation angle at distance was established as an independent factor for predicting total exotropia score (P = .037, P = .015, respectively). CONCLUSIONS: The high deviation angle correlates positively with poor deviation control. The distance deviation angle is an independent predictor of total deviation control for the first time in the literature. [J Pediatr Ophthalmol Strabismus. 2022;59(1):53-59.].

A Case of Best Disease Accompanied by Pachychoroid Neovasculopathy

The aim of this case presentation is to describe ocular findings of a 22-year-old patient with Best vitelliform macular dystrophy accompanied by pachychoroid neovasculopathy. Color fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) images were reviewed. Funduscopic examination showed bilateral yellowish vitelliform-like submacular deposits. FAF revealed these deposits as hyperautofluorescent spots. OCT showed flat irregular pigment epithelial detachments corresponding to these submacular deposits. OCT showed choroidal thickening and dilatation of the large outer oval choroidal vessels. Fundus fluorescein angiography could not be performed because the patient was pregnant. En face OCTA images of the choriocapillaris illustrated the choroidal neovascular network. In this case report, we describe for the first time the coexistence of Best vitelliform macular dystrophy and pachychoroid neovasculopathy with OCTA images enabling visualization of the neovascular network in a patient with contraindication for fluorescein angiography.

Inadvertent intralenticular dexamethasone implant: 1-year follow-up and management.

We report the case of a 72-year-old female who developed macular edema (ME) due to hemicentral retinal vein occlusion in her right eye. A dexamethasone implant was inadvertently injected into the crystalline lens. The patient was followed without repositioning of the dexamethasone implant during the 12 months. Besides, the posterior subcapsular cataract and ME had progressed significantly; hence, cataract extraction and intravitreal ranibizumab injection were performed in the same session. A three-piece intraocular lens was implanted in the sulcus with optic captured, and then intravitreal ranibizumab injection was performed. The patient had an uncomplicated postoperative recovery. At 2 months, best-corrected visual acuity was 0.7, and the macula was dry.

Comparison of the measurements of a novel optical biometry: Nidek AL-Scan with Sirius and a ultrasound biometry.

To investigate the accuracy of the measurements of Nidek AL-Scan by comparing with Sirius (CSO, Florence, Italy), a corneal tomography which also employs the Scheimpflug principle, and a commonly used device, ultrasound biometry (UB) (Aviso A/B, Quantel Medical, MT, USA). Right eyes of 85 healthy volunteers (58 women 27 men) with a mean age of 39.24 ± 14.37 years (range 15-68) were enrolled into this comparative prospective study. Average K 2.4, average K 3.3, CCT (central corneal thickness), WTW (white to white distance), ACD (anterior chamber depth) and AL (axial length) were obtained from the AL-Scan and compared with average SimK, CCT, WTW (horizontal anterior chamber diameter) and ACD obtained from Sirius and also compared with ACD and AL obtained from UB. The statistically significant difference was found between all of the measurements (p < 0.001) except the average keratometry values (K2.4, K3.3, SimK) (p = 0.083). There was a perfect correlation between keratometry, CCT and AL measurements of the devices (ICC = 0.977, 0.954, 0.923, respectively) and there was a strong correlation between the WTW measurements of AL-Scan and Sirius (ICC = 0.865). While ACD parameter of AL-Scan and UB showed a perfect correlation (ICC = 0.977), there was a moderate correlation between AL-Scan and Sirius and also between UB and Sirius (ICC = 0.608 and 0.664, respectively). There was a high correlation between the all measurements, besides ACD, of AL-Scan and Sirius and they can be used interchangeably for average keratometry and WTW confidently. However, ACD and CCT have a broader 95 % LoA (-0.039 to 0.744 and -24.985 to 3.691, respectively). In addition, AL-Scan and UB were in good agreement regarding ACD, while differences in AL measurements of UB and AL-Scan were clinically important (95 % LoA = -0.091 to 0.703). Furthermore, UB and Sirius have a moderate agreement regarding ACD (95 % LoA = -0.047 to 0.680).

Reduced ocular surface disease index (OSDI) scores in patients with isotretinoin treatment.

To evaluate the changes in ocular surface and functions of tear-film in patients treated with systemic isotretinoin, to assess diagnostic performance of ocular surface disease index (OSDI) test in the dry eye conditions in association with the use of isotretinoin, and to determine the correlation between all tear-film function tests, OSDI and the dose and duration of isotretinoin administration. One hundred and twenty eyes of 60 subjects treated with oral isotretinoin were enrolled. All patients underwent ophthalmic examination at the baseline and another examination during the course of treatment. Biomicroscopic ophthalmic examination of the meibomian glands, non-anesthetized Schirmer test, and tear film break-up time (BUT) were performed. Subjective ocular complaints were scored with an OSDI questionnaire. Average Schirmer scores were not significantly changed by isotretinoin treatment. There were significant differences in the average OSDI score, the average meibomian gland disease (MGD) grade and average BUT value of both eyes during the treatment compared with baseline values (p < 0.01). There was a statistically significant inverse correlation between MGD grade and BUT value. There was no significant correlation between BUT value, OSDI score, Schirmer score, MGD grade, the total and divided dose of isotretinoin and the duration of treatment. The follow-up time was 4.01 ± 1.3 months (range 1.5-6 months). Systemic isotretinoin treatment can cause alterations in the tear film and dry eye symptoms. The OSDI test can be used as a diagnostic test for patients receiving systemic isotretinoin treatment.

Comparison of Heidelberg Retina Tomograph-3 glaucoma probability score and Moorfields regression analysis of optic nerve head in glaucoma patients and healthy individuals.

PURPOSE: To compare the sensitivity and specificity of Moorfields regression analysis (MRA) and glaucoma probability score (GPS) between healthy and glaucomatous eyes with Heidelberg Retinal Tomograph 3 (HRT-3). METHODS: The study included 120 eyes of 75 glaucoma patients and 138 eyes of 73 normal subjects, for a total of 258 eyes of 148 individuals. All measurements were performed with the HRT-3. Diagnostic test criteria (sensitivity, specificity, etc.) were used to evaluate how efficiently GPS and MRA algorithms in the HRT-3 discriminated between the glaucoma and control groups. RESULTS: The GPS showed 88 % sensitivity and 66 % specificity, whereas MRA had 71.5 % sensitivity and 82.5 % specificity. There was 71 % agreement between the final results of MRA and GPS in the glaucoma group. Excluding borderline patients from both analyses resulted in 91.6 % agreement. In the control group the level of agreement between MRA and GPS was 64 % including borderline patients and 84.1 % after excluding borderline patients. The accuracy rate is 92 % for MRA and 91 % for GPS in the glaucoma group excluding borderline patients. The difference was nor statistically different. In both cases, agreement was higher between MRA and GPS in the glaucoma group. We found that both sensitivity and specificity increased with disc size for MRA, while the sensitivity increased and specificity decreased with larger disc sizes for GPS. CONCLUSIONS: HRT is able to quantify and clearly reveal structural changes in the ONH and RNFL in glaucoma.

The Stabilization Time of Ocular Measurements after Cataract Surgery.

PURPOSE: To determine the stabilization time of automated refraction, ocular biometric parameters, keratometry, and central corneal thickness (CCT) and to find the optimal time for glasses' prescription after cataract surgery. METHODS: This was a prospective, case series study of 62 consecutive eyes with senile cataracts. Patients undergoing uncomplicated phacoemulsification surgery were included in the study. Automated refraction, keratometry, ocular biometric parameters, and CCT were recorded at baseline before cataract surgery and at follow-up visits at one day, one week, two weeks, and four weeks after surgery. RESULTS: The study was composed of 62 eyes of 62 patients with a mean age of 66±12.38 (range, 40 to 84 years). The automated refraction stabilized one week after surgery and changed minimally between the first week and the first month after cataract surgery. The stabilization of average keratometric corneal astigmatism in keratometry, average anterior chamber depth, and CCT was achieved after the second postsurgical week. CONCLUSION: It may be possible to prescribe glasses starting from two weeks after an uneventful phacoemulsification cataract surgery for most patients.

A bibliometric analysis of academic publication on diabetic retinopathy disease trends during 1980-2014: a global and medical view.

AIM: To investigate diabetic retinopathy (DR) literature using the Institute for Scientific Information (ISI) Web of Science (WoS) database and to analyse the correlation results between socio-economic development datas and number of DR publications. METHODS: The statistical analysis of the documents published during 1980-2014 was analysed. The data of this study were based on the database of WoS. "Diabetic retinopathy" was used as the keywords to search the WoS database. RESULTS: The United States ranked first in the DR research with 1840 publications and 24.38% of the world production followed by England and Japan. Besides, the most productive country was Iceland. A high correlation was found between number of publications and 2014 gross domestic product (GDP) values of 81 countries (r=0.800, P<0.001). We found a significant correlation between number of publications and Human Development Index (HDI) (r=0.645, P=0.001). There is a moderate correlation between people with diabetes and number of DR publications for 81 countries (r=0.514, P<0.01). It could be analysed that estimated publication number with DR title will be 445 according to the regression curve constituted with cubic model in 2015 (R2=1.000). CONCLUSION: More DR studies have been published in developed countries, DR and other complications of diabetes have gradually increased in developing countries over recent decades. It can be expected that the number of DR studies will gradually increase in developing countries.

In Vivo Confocal Microscopy and Biomicroscopy of Filtering Blebs After Trabeculectomy.

PURPOSE: The aim of this study is to analyze filtering blebs (FBs) after trabeculectomy with in vivo confocal microscopy (IVCM) and slit-lamp biomicroscopy. MATERIALS AND METHODS: IVCM using the Heidelberg Retina Tomograph/Rostock Cornea Module and biomicroscopic examination were performed in 67 FBs in 55 patients 3 months to 30 years postoperatively (mean, 3.2 ± 2.1 y). Although the blebs were evaluated by slit-lamp biomicroscopy, standardized FB classification was used. RESULTS: Of the patients, 9 were female (16.3%) and 46 were male (83.7%), ranging in age from 32 to 81 (51.5 ± 13.2) years. The absence of vascularization and tortuous vessels and the presence of epithelial microcysts on the bleb were significantly correlated with good bleb function (P=0.001). IVCM findings significantly correlated with good bleb function, including the number of epithelial microcysts (P=0.002), the stromal cysts without capsule (P<0.001), minimal vascularization (P=0.002), and the absence of tortuous conjunctival vessels (P=0.003) and reticular and trabecular bleb patterns (P=0.01 and <0.01, respectively). In contrast, a hyperreflective condensed bleb stroma was significantly associated with bleb failure (P<0.001). CONCLUSIONS: IVCM supports biomicroscopic evaluation as the mainstay for FB analysis and permits diagnostic imaging of FBs to evaluate and follow-up the bleb, differentiation between good and insufficient bleb function, and a microscopic analysis at a cellular level including the structural pattern of the bleb.

The Modified Technique of External Dacryocystorhinostomy in the Management of Complicated Nasolacrimal Duct Obstruction.

AIM: To evaluate the outcome of the modified technique of external dacryocystorhinostomy (EDCR) with a "U"-shaped single flap that was fixed on to the orbicularis muscle with combined silicone tube in dacriostenosis. In cases with decreased visibility because of excessive bleeding during surgery, a small sac size, and difficulty of mutual suturing between nasal mucosal and sac flaps related to distance. METHODS: This retrospective study included 118 patients with a nasolacrimal duct obstruction who underwent the modified technique of EDCR. The modified EDCR procedure envisions the creation of anastomosis of the single anterior "U"-shaped flaps suturing anterior flaps of the lacrimal sac and nasal mucosa. The sutured flap was fixed on to the orbicularis muscle. The silicone tube intubation was performed on all patients. RESULTS: The average age of the patients was 39 ±â€Š19.2 (9-70) years, including 94 women and 24 men. The average follow-up time was 18 ±â€Š4.5 (9-36) months. Total 112 eyes (94.9%) showed a patent lacrimal system to irrigation, whereas 6 eyes (5.1%) had recurrence of epiphora and not patent lacrimal system to irrigation by the end of the first surgeries. The same surgery was planned for these patients. The patent lacrimal system was achieved in 3 of these 6 eyes. The overall success rate of the surgical procedure used in this study was 97.4%. CONCLUSIONS: This modified technique of EDCR with a "U"-shaped single anterior flaps that was fixed on to the orbicularis muscle with combined silicone tube simplifies the surgical procedure and is effective in the management of nasolacrimal duct obstruction.

Isolated sixth nerve palsy after intravitreal ranibizumab injection.

After intravitreal ranibizumab injection for diabetic macular edema (DME) in a 55-year-old man, the patient was admitted to our ophthalmology clinic with the complaint of diplopia. Given the results of the patient's history, physical exam, and negative magnetic resonance imaging (MRI), we believed that the patient had a sixth nerve palsy related to ranibizumab injection. To the best of our knowledge, this is the first case with isolated abducens palsy after ranibizumab injection.

Ocular biometry and central corneal thickness in children: a hospital-based study.

PURPOSE: To investigate the distribution of axial length, anterior chamber depth, lens thickness, vitreous chamber depth, and central corneal thickness in children at different age groups. METHODS: We studied 364 eyes in 182 children with ages between 1 and 12 years. Axial length, anterior chamber depth, lens thickness, and vitreous chamber depth were measured by ultrasound biometry. Central corneal thickness was measured by ultrasound pachymetry in all children. RESULTS: The mean age was 6.54 ・} 3.42 years. The axial length was 20.95 mm in 1-2 years old and 22.95 mm in 11-12 years old. The central corneal thickness was 556 µm in 1-2 years old and 555 µm in 11-12 years old. The mean anterior chamber depth and vitreous chamber depth increased with age (3.06 mm to 3.44 mm in anterior chamber depth, 13.75 mm to 15.99 mm in vitreous chamber depth), and the lens thickness decreased as age increased (3.67-3.51 mm). CONCLUSION: The axial length increased with age and reached adult levels by the age of 9-10 years. The lens thickness gradually decreased until 12 years. The central corneal thickness measurements did not yield a linear algorithm.

Ocular biometry and central corneal thickness in children: a hospital-based study / Biometria ocular e espessura corneana central em crianças: um estudo de base hospitalar

Purpose: To investigate the distribution of axial length, anterior chamber depth, lens thickness, vitreous chamber depth, and central corneal thickness in children at different age groups. Methods: We studied 364 eyes in 182 children with ages between 1 and 12 years. Axial length, anterior chamber depth, lens thickness, and vitreous chamber depth were measured by ultrasound biometry. Central corneal thickness was measured by ultrasound pachymetry in all children. Results: The mean age was 6.54 ± 3.42 years. The axial length was 20.95 mm in 1-2 years old and 22.95 mm in 11-12 years old. The central corneal thickness was 556 µm in 1-2 years old and 555 µm in 11-12 years old. The mean anterior chamber depth and vitreous chamber depth increased with age (3.06 mm to 3.44 mm in anterior chamber depth, 13.75 mm to 15.99 mm in vitreous chamber depth), and the lens thickness decreased as age increased (3.67-3.51 mm). Conclusion: The axial length increased with age and reached adult levels by the age of 9-10 years. The lens thickness gradually decreased until 12 years. The central corneal thickness measurements did not yield a linear algorithm. .

Objetivo: Investigar a distribuição do comprimento axial, profundidade da câmara anterior, espessura do cristalino, profundidade da câmara vítrea e espessura corneal central em crianças em diferentes faixas etárias. Métodos: Foram estudados 364 olhos de 182 crianças entre 1 e 12 anos de idade. O comprimento axial, a profundidade da câmara anterior , a espessura do cristalino e a profundidade da câmara vítrea foram medidos por biometria ultrassônica. A espessura corneal central foi medida por paquimetria ultrassônica em todas as crianças. Resultados: A idade média foi de 6,54 ± 3,42 anos. O comprimento axial foi 20,95 mm no grupo de 1-2 anos de idade e 22,95 mm no grupo de 11-12 anos de idade. A espessura corneal central foi 556 µm no grupo de 1-2 anos de idade e 555 µm no grupo de 11-12 anos de idade. A profundidade da câmara anterior média e profundidade da câmara vítrea aumentou com a idade (3,06 mm a 3,44 mm de profundidade da câmara anterior, 13,75 mm a 15,99 mm de profundidade da câmara vítrea) e da espessura do cristalino diminuiu com o aumento da idade (3,67 mm a 3,51 mm). Conclusões: Em nosso estudo, os valores do comprimento axial aumentou com a idade e atingiu os níveis adultos aos 9-10 anos de idade. A espessura do cristalino diminuiu gradualmente até os 12 anos de idade. As medições de espessura corneal central não seguiu um algoritmo linear. .

The effectiveness of postoperative early ostium cleaning in transcanalicular diode laser-assisted dacryocystorhinostomy.

PURPOSE: To search the effectiveness of postoperative first week ostium cleaning in transcanalicular diode laser-assisted dacryocystorhinostomy (TDL-DCR). MATERIALS AND METHODS: A total of 123 eyes of 123 patients with acquired dacryostenosis who had surgery were retrospectively evaluated. Diode laser was used in all patients. All patients were operated under local anesthesia by a single surgeon. Intranasal endoscopic cleaning of the ostium by surgical suction under local anesthesia was performed as an extra job in the postoperative first week visit. RESULTS: Mean age of the patients was 55 (range, 41-78 years) years. Mean follow up was 13.4 months. Successful outcomes were achieved in 117 of 123 (95.1%) patients. Reoperation was performed in 6 patients with restenosis and were free of symptoms in 1-year follow up. CONCLUSION: Postoperative first week cleaning of the nasal ostium by surgical suction with the aiding of nasal endoscopy is a very effective method increasing the success rate of TDL-DCR.