Comparison of Ganglion Cell and Retinal Nerve Fiber Layer Thickness in Pigment Dispersion Syndrome, Pigmentary Glaucoma, and Healthy Subjects with Spectral-domain OCT.

PURPOSE: To evaluate the ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) thickness in pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG) with RTVue spectral domain optical coherence tomography (SD-OCT). METHODS: A total of 102 subjects were enrolled: 29 with PDS, 18 with PG, and 55 normal subjects. Full ophthalmic examination including visual field analysis was performed. SD-OCT was used to analyze GCC superior, GCC inferior, and average RNFL thickness. To compare the discrimination capabilities, the areas under the receiver operating characteristic curves were assessed. RESULTS: Superior GCC, inferior GCC, and RNFL thickness values of patients with PG were statistically signicantly lower than those of patients with PDS (p < 0.001) and healthy individuals (p < 0.001 for all). No statistically significant difference was found between PDS and normal subjects in same parameters (p > 0.05). CONCLUSIONS: The SD-OCT-derived GCC and RNFL thickness parameters can be useful to discriminate PG from both PDS and normal subjects.

Effectivity of intraoperative adjustable suture technique in horizontal strabismus.

AIM: To compare the long-term effectivity of intraoperative adjustable suture technique with traditional non-adjustable strabismus surgery. METHODS: Two hundred and thirty-three patients, who underwent strabismus surgery either with traditional procedures or one-stage intraoperative adjustable suture technique, were included in our long-term follow-up study. One hundred and eighteen patients were evaluated in traditional surgery group (TSG) and 115 who underwent adjustable suture were in the one-stage intraoperative adjustable surgery group (ASG). In this group 9 patients had paralytic strabismus and 16 had reoperations, 2 patients had restrictive strabismus related to thyroid eye disease. The mean follow up in the TSG was 26.2 months and it was 24.8 months in the ASG group. RESULTS: In patients with exotropia (XT) the mean correction of deviation for near fixation in ASG (32.4±13.2PD) and in TSG (26.4±8.2PD) were similar (P=0.112). The correction for distant fixation in ASG (33.2±11.4PD) and TSG (30.9±7.2PD) were not significantly different (P=0.321). In patients with esotropia (ET) even the mean correction of deviation for both near (31±12PD) and distant (30.6±12.8PD) fixations were higher in ASG than in TSG, for both near (28.27±14.2PD) and distant (28.9±12.9PD) fixations, the differences were not significant (P=0.346, 0.824 respectively). The overall success rate of XT patient was 78.9% in TSG and 78.78% in ASG, the difference was not significant (P=0.629). The success rates were 78.75% in TSG and 75.51% in ASG in ET patient, which was also not significantly different (P=0.821). CONCLUSION: Although patients in ASG had more complex deviation such as paralysis, reoperations and restrictive strabismus, success rates of this tecnique was as high as TSG which did not contain complicated deviation. One-stage intraoperative adjustable suture technique is a safe and effective method for cooperative patient who has complex deviation.

Early retinal and retinal nerve fiber layer effects of hydroxychloroquine: a follow up study by sdOCT.

CONTEXT: The antimalarial drug hydroxychloroquine (HCQ), used in the treatment of rheumatologic disease, has been associated with the development of retinopathy. The long-term incidence of HCQ retinopathy has been estimated at 0.5% when recommended dosages (≤6.5 mg/kg per day) are used. OBJECTIVE: Evaluating the patients for whom HCQ treatment will be started before and after treatment prospectively with spectral domain (sd) optical coherence tomography (OCT) to observe possible early changes in the retinal and retinal nerve fiber layer thickness. MATERIALS AND METHODS: Thirty-six patients from rheumatology clinic who have been started HCQ therapy had clinical examination and sdOCT imaging before and 6 months after starting treatment. The baseline ophthalmological examinations and visual field analysis (on automated Humphrey visual field (HVF) 10-2 perimetry, Humphrey HFA II-i 750 i, Carl Zeiss Meditec AG, Jena, Germany) were completely normal. The sdOCT was performed with the Optovue technology according to the manufacturer's guidelines using EMM5, retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) scans. The retinal thickness values in central foveal, inferior and superior hemispheres, temporal, superior, nasal and inferior para- and perifoveal areas and the RNFL thickness of eyes were compared before and 6 months after starting treatment by the paired t test. RESULTS: The retinal thickness values in central parafoveal (p = 0.02), and superior hemisphere (p = 0.01) in parafoveal area, parafoveal superior (p = 0.02), temporal (p = 0.03) and nasal (p = 0.04) quadrants were significantly thicker after 6 months of treatment. The thickness of the perifoveal area and the average RNFL thickness was not significantly different in any of the quadrants before and after starting HCQ treatment. The GCC thickness also did not change significantly different in superior and inferior hemisphere after starting treatment. DISCUSSION AND CONCLUSION: We observe increased retinal thickness in parafoveal areas in patients on HCQ therapy at short term. Its clinical significance may be apparent in longer follow up studies.

Long-term effects of prostaglandin analogues on the anterior chamber depth of patients with primary open-angle glaucoma.

OBJECTIVE: To evaluate the effect of long-term application of bimatoprost and latanoprost on the anterior chamber depth of primary open-angle glaucoma patients. METHODS: The anterior chamber depth (ACD) and axial length (AL) of patients using prostaglandin analogues for open-angle glaucoma (group I) and an age- and gender-adjusted control group (group II) were measured by ultrasonography. Patients using bimatoprost and those using latanoprost were also compared in terms of ACD and AL. RESULTS: The mean ACD of group I (27 eyes of 27 subjects) was significantly lower than that of group II (30 eyes of 30 subjects) (p = .012). Similarly, the ratio of ACD to AL was significantly lower in group I compared with group II (p = .001). The ACDs of patients using bimatoprost or latanoprost and the control group were not significantly different by Kruskal-Wallis test (p = .056), but the differences of these 3 groups in ACD/AL ratios were significant (p = .004). When the Mann Whitney U test was used for pairwise comparison, there was a significant difference between the control group and the patients using latanoprost or bimatoprost in terms of the ACD/AL ratio (p = .008 for each). There was no difference between the patients using latanoprost and those using bimatoprost in terms of the ACD/AL ratio (p = .4). CONCLUSION: The ACD of patients on prolonged therapy with prostaglandin analogues seems to be lower than than that of the control group. However, prospective long-term studies on large number of subjects are needed to evaluate the effect of each type of prostaglandin on ocular structures.

Gout attack with unusual ocular complications.

Uveitis is reported in vanishingly small numbers in gout. This case with bilateral uveitis, increased intraocular pressure and blurred disc margins may unravel strange ocular complications of the disease and arise awareness of gout while prescribing diuretics and cyclosporine in patients with uveitis and increased intraocular pressure.

Is SHORT syndrome another phenotypic variation of PITX2?

Even though responsible genetic loci and mode of inheritance for the Rieger syndrome have been well established, the mode of inheritance and the genetic basis for SHORT syndrome are still uncertain. The purpose of this paper is to document a familial translocation of t(1;4)(q31.2;q25), in a mother and her son manifesting Rieger syndrome with polycystic ovaries and SHORT syndrome, respectively. It is suggested that these two syndromes may be different expressions of the same gene, PITX2, localized at 4q25. Our patient is the second with the association of Rieger syndrome and polycystic ovaries, and thus this may not be coincidental, moreover insulin resistance-related phenotypes, such as lipodystrophy and polycystic ovaries, can be major component of syndromes with Rieger eye malformation.

Primary viscocanalostomy versus trabeculectomy for primary open-angle glaucoma: three-year prospective randomized clinical trial.

PURPOSE: To compare the efficacy and safety of viscocanalostomy and trabeculectomy in patients with primary open-angle glaucoma (POAG). SETTING: Department of Ophthalmology, Ankara Education and Research Hospital, Ankara, Turkey. METHODS: In this prospective randomized trial, 50 eyes of 50 patients with medically uncontrolled POAG were randomized to have a trabeculectomy (25 eyes) or a viscocanalostomy (25 eyes). Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before surgery and 1 day, 1 week, 1, 3, and 6 months, and 1, 2, and 3 years postoperatively. RESULTS: At 3 years, the mean IOP was 16.0 mmHg +/- 7.07 (SD) in the trabeculectomy group and 17.8 +/- 4.6 mmHg in the viscocanalostomy group (P=.694). Complete success (IOP 6 to 21 mm Hg without medication) was achieved in 66.2% of eyes at 6 months and 55.1% at 3 years in the trabeculectomy group and in 52.9% and 35.3%, respectively, in the viscocanalostomy group (P>.05). Qualified success (IOP 6 to 21 mmHg with medication) was achieved in 95.8% of eyes at 6 months and 79.2% at 3 years in the trabeculectomy group and in 90.7% and 73.9%, respectively, in the viscocanalostomy group (P>.05). Postoperative hypotony and cataract formation occurred more frequently in the trabeculectomy group than in the viscocanalostomy group (P=.002). CONCLUSIONS: Primary trabeculectomy lowered IOP more than viscocanalostomy in POAG patients. However, the complication rate was lower in the viscocanalostomy group.

Evaluation of findings in Crouzon's syndrome.

PURPOSE. The purpose of this study was to investigate the ocular, facial and radiological signs of Crouzon's syndrome in a group of older patients who had not undergone previous craniofacial surgery. METHODS. Six cases of Crouzon's syndrome, four of whom belonged to a three-generation family, were examined systemically, ophthalmologically and roentgenographically; five of these cases were additionally evaluated with computed tomography and compared with Apert syndrome. RESULTS. On radiologic evaluation, all cases had synostosis of all cranial sutures and fontanelles and brachycephalic skulls, crowding of the upper teeth due to maxillary hypoplasia, and serious nasal septum deviation. Bilateral ethmoidal, maxillary and sphenoidal chronic sinusitis was found in 50% of cases. Three patients had hypertelorism and two others had a tendency toward hypertelorism. The typical facial appearance with shallow orbits, globe protrusion and exorbitism was present in all cases. Two of them had V-pattern exotropia while the other four were orthophoric. The single case with mental retardation had bilateral cataract. CONCLUSION. Crouzon's syndrome can present with different findings and must be evaluated multidisciplinarly.