Prematurity May Affect the Postoperative Sensory Results in Children With Strabismus.

PURPOSE: To analyze the motor and sensory outcomes of strabismus surgery in children born preterm (premature group) and full-term (control group). METHODS: The study was performed at a tertiary university hospital. Children who underwent strabismus surgery between 2012 and 2019 were retrospectively reviewed. The success of surgery, postoperative over-correction and undercorrection rates, and stereopsis and fusion test results were compared between the premature and control groups. RESULTS: There were 70 patients in the premature group (mean gestational age: 31.25 weeks; range: 24 to 35 weeks) and 242 patients in the control group. The amounts of preoperative and postoperative deviations and overcorrection, undercorrection, and success rates were similar between the premature and control groups (P > .05). Stereopsis improved from 560 to 300 arc/sec postoperatively in the premature group (P = .066) and from 1,156 to 685 arc/sec in the control group (P < .001). The rate of fusion increased from 12.5% to 25% in the premature group (P = .50) and from 17% to 47% in the control group (P < .001). The analysis of strabismus subgroups revealed significant improvement of fusion in full-term patients (P < .001) and not in preterm patients (P = .50) with esotropia. Preoperative amount of deviation was the only risk factor for surgical success (P < .001). Age, sex, history of prematurity, and spherical equivalent refraction were not correlated with undercorrection (P > .05). CONCLUSIONS: Regardless of the type of strabismus, although the functional results after strabismus surgery were similar in preterm and full-term patients, the gain of stereopsis and central fusion was significantly higher in full-term patients compared to preterm patients. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Success rates of botulinum toxin in different types of strabismus and dose effect.

OBJECTIVE: To determine the effect of botulinum toxin in different types of strabismus and analyze its dose effect. DESIGN: This was an interventional clinical study performed in a tertiary care university hospital. METHODS: Eighty six patients treated with botulinum toxin for strabismus were included. Main outcome measures involved success of botulinum toxin, alignment change per unit of toxin, and dose effect on complications and outcomes. RESULTS: Success rates were 31% for infantile esotropia, 25% for partially accommodative esotropia, 61.5% for residual esotropia, 25% for third cranial nerve paralysis, 13.3% for sixth cranial nerve paralysis, 75% for Duane retraction syndrome, and 38.5% for nonaccomodative esotropia. Improvement in deviation size after botulinum toxin treatment was significant in patients with infantile esotropia (p = 0.001), residual esotropia (p = 0.001), and nonaccomodative esotropia (p = 0.03). Mean deviation change per 1 unit of toxin was 2.7 ± 2.4 prism diopters (PD) with a single injection and 2.1 ± 1.9 PD with multiple injections. A 3.32 PD of early deviation change with botulinum toxin corrected 1 PD of final deviation. Success rate was not correlated with age (r = 0.040, p = 0.8), sex (r = -0.083, p = 0.6), mean dose (r = -0.149, p = 0.35), or total dose (r = 0.165, p = 0.29) but was significantly correlated with deviation size (ß = -0.077, p = 0.0001). Complications were not associated with the dose of botulinum toxin (p > 0.05). CONCLUSIONS: Botulinum toxin has variable outcomes in different types of strabismus. Still, it reduces the deviation size in most patients, thus allowing for a smaller amount of subsequent muscle surgery. Early overcorrection is a more powerful indicator of better outcome than postinjection duction deficit.

Aqueous humor and serum levels of 4-hydroxynonenal and 8-hydroxy-2'deoxyguanosine in pseudoexfoliation syndrome and glaucoma.

PURPOSE: To compare the aqueous humor (AH) and serum levels of 4-hydroxynenal (4-HNE) and 8-hydroxy-2'-deoxyguanosine (8-OhdG) in patients with pseudoexfoliation syndrome (PES) and pseudoexfoliation glaucoma (PEG) with each other and with age- and sex-matched control group. METHODS: This prospective study included 66 patients divided into three groups: PES (n = 24), PEG (n = 21), and a control group (n = 21). 4-HNE and 8-OhdG levels were analyzed using the enzyme-linked immunosorbent assay. RESULTS: Aqueous and serum 4-HNE levels were significantly higher in the PEG (466.52 ± 62.12 pg/mL and 313.47 ± 47.41 pg/mL) and PES (290.69 ± 63.63 pg/mL and 201.53 ± 39.57 pg/mL) groups than the control group (144.02 ± 39.58 pg/mL and 99.10 ± 16.96 pg/mL; p < 0.001, for all). Both aqueous and serum levels of 4-HNE in the PEG group were significantly higher than in the PES group (p < 0.001, for both). Similar to 4-HNE, the AH 8-OhdG levels were higher in the PEG group (21.18 ± 2.23 ng/mL) compared to the PES (14.90 ± 3.37 ng/mL) and control (4.86 ± 1.94 ng/mL) groups (p < 0.001, for all). Serum 8-OhdG levels were significantly higher in the PEG and PES groups than the control (p < 0.001, for both); however, there was no significant difference between the PES and PEG groups (p = 0.097). There were strong significant correlations between the aqueous and serum levels of 4-HNE (p < 0.001, r = 0.857) and 8-OhdG (p < 0.001, r = 0.807) among all the patients. CONCLUSIONS: Aqueous humor and serum levels of 4-HNE and 8-OhdG increased in the PES and PEG patients. These findings are potentially significant and add to the growing body of evidence concerning oxidative stress in PES and PEG.

Incidence and risk factors for retinopathy of prematurity in premature, extremely low birth weight and extremely low gestational age infants.

BACKGROUND: The aim of the study was to determine the incidence and risk factors of retinopathy of prematurity (ROP) in premature, extremely low birth weight (BW, ELBW) and extremely low gestational age (GA, ELGA) infants. METHODS: The medical records of preterm infants who were screened for ROP between January 2012 and December 2020 were retrospectively reviewed. Only one eye of each infant with higher grade ROP was included in the study. BW; GA; medical characteristics; the presence, severity, and need for treatment of ROP were recorded. Infants were divided into groups according to BW (≤1000 g, 1001-1750 g, > 1750 g) and GA (≤25w, 26-28w, 29-31w, 32-34w, ≥35w) and data were analyzed. RESULTS: Data of 2186 infants were evaluated. The overall incidences of any stage ROP and ROP requiring treatment were 43.5 and 8.0%, respectively. These rates were 81.1 and 23.9% in ELBW (≤1000 g) infants and were 92.9 and 64.3% in ELGA (≤25w) infants, respectively. The rates of ROP, the median duration of oxygen therapy and systemic diseases increased significantly as BW and GA decreased. The median duration of oxygen therapy and the rates of sepsis, pulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) were statistically higher in infants with ROP compared to those without ROP (p < 0.001). Multivariate regression analysis demonstrated that low BW and GA; prolonged duration of oxygen therapy; presence of PDA and necrotizing enterocolitis (NEC) were important risk factors for ROP. CONCLUSIONS: ELBW and ELGA infants develop higher rates of ROP and severe ROP. Prolonged duration of oxygen therapy, the presence of concomitant neonatal sepsis, BPD, IVH, PDA, and NEC further increases the risk of ROP.

Corneal Endothelial Layer Parameters in Patients Undergoing Strabismus Surgery.

PURPOSE: To investigate the effects of horizontal and oblique strabismus surgery on the corneal endothelial cell layer. METHODS: Eighty-three eyes of 56 patients were prospectively evaluated. Corneal endothelial cell layer analysis was performed with a specular microscopy device (EM-3000; Tomey Corporation) preoperatively and 1 day, 2 weeks, and 2 months postoperatively. Endothelial cell density, coefficient of variation, average cell area, standard deviation (SD) of the endothelial cell area, hexagonality, and central corneal thickness (CCT) were evaluated. RESULTS: Endothelial cell density, average cell area, and SD of the endothelial cell area did not show a statistically significant change postoperatively. In the one and two horizontal muscle surgery groups, the hexagonality measurements 2 weeks postoperatively were significantly lower compared to preoperative values. In the one horizontal muscle surgery group and when all patients were examined, CCT 1 day postoperatively was significantly higher than 2 weeks postoperatively. No significant change was observed postoperatively in any of the endothelial parameters in the oblique surgery group. Spherical equivalent was positively correlated with endothelial cell density and CCT, and it was negatively correlated with the average cell area and age. Age was positively correlated with the average cell area and the SD of the endothelial cell area, negatively correlated with endothelial cell density and hexagonality, and was not correlated with the coefficient of variation or CCT. CONCLUSIONS: There is a temporary effect of horizontal strabismus surgery on hexagonality and corneal thickness. A definite decrease in cellular hexagonality occurs as the number of endothelial cells decrease and cell areas increase with age. [J Pediatr Ophthalmol Strabimus. 2021;58(4):254-260.].

Chromosomal microarray analysis of patients with Duane retraction syndrome.

PURPOSE: Duane retraction syndrome (DS) is a rare congenital strabismus with genetic heterogeneity. The genetic causes of DS are not always of monogenic origin; various chromosomal copy number variations (CNVs) have also been reported. The objective of our study was to characterize the CNVs, including gains and losses detected by high-resolution chromosomal microarray in patients with DS. METHODS: Twenty patients with DS were investigated using high-resolution chromosomal microarray analysis (CMA) (Affymetrix CytoScan Array 750 K). Conventional cytogenetic analysis was also performed. RESULTS: All samples revealed normal karyotype by cytogenetic analysis. However, in all our patients, multiple CNVs, including gains and losses, were detected using the high-resolution CMA method. Chromosomal loci 1q21.2, 2p11.2-q11.1, 2q21.1-q21.2, 4p16.1, 7p11.2-q11.21, 14q32.33, 17p11.2-q11.1 and 20p11.1-q11.21 were the most frequently affected regions. CONCLUSIONS: This study emphasized that CNVs in several chromosomal regions are known to be involved in DS. We also underscore the genetic heterogeneity of DS. Our suggestion is that genes located in the most frequently affected regions should be focused on in the following candidate gene studies.

The effect of strabismus surgery on choroidal thickness.

PURPOSE: To determine the effects of strabismus surgery on choroidal thickness. METHODS: This was a prospective randomized study. The measurements of subfoveal and macular choroidal thickness of patients who underwent strabismus surgery were obtained by enhanced depth imaging optic coherence tomography. The patients were grouped as patients who had 1 horizontal muscle surgery (group 1), 1 oblique muscle surgery (group 2), 2 horizontal muscle surgeries (group 3), or 1 horizontal and 1 oblique muscle surgery (group 4). Choroidal thickness of the patients was measured preoperatively and on the postoperative first day, second week, first month, and third month. Choroidal thickness was measured at subfoveal area (S) and at the nasal (N1, N2) and temporal (T1, T2) fovea with 500-µm intervals. RESULTS: The average age of the 37 patients was 15.59 ± 13.84 years. In preoperative and postoperative first day comparison, a decrease in choroidal thickness was found in all areas in group 1. In group 2, a significant decrease was found in N2, N1, and S values. In group 3, a significant decrease was found in N2, N1, and T2 values. In group 4, a significant decrease was found in N1 value. The second week comparison of all groups showed significant postoperative decrease in choroidal thickness in all areas. On the postoperative first month, a significant decrease in choroidal thickness was found only in the subfoveal area of group 1 and the N1 area of group 2. At the postoperative third month, there was no change in any group. CONCLUSIONS: Strabismus surgery causes a decrease in choroidal thickness in the early postoperative period.

Medial and Lateral Rectus Muscle Insertion Distance and Width in Esotropia and Exotropia Patients.

PURPOSE: The hypothesis that the extraocular muscle insertion distance and muscle width may be associated with the type and size of deviation was tested. METHODS: This was a prospective study of 129 patients who had surgery for horizontal strabismus or retinal detachment. The insertion distances and widths of the medial rectus (MR) and lateral rectus (LR) muscles were measured intraoperatively in esotropia, exotropia, and buckling surgery (control group) patients. Statistical analysis was performed to compare measured factors between the groups. RESULTS: Median medial and lateral muscle insertions were 5.7 and 6.9 mm in esotropia (ET), 6.0 and 7.1 mm in exotropia (XT), and 5.5 and 6.7 mm in the control groups (p > 0.05). The widths of the medial and lateral muscles ranged from 7.0 to 13.0 mm in ET and XT groups and from 9.5 to 11.0 mm in the control group (p > 0.05). Muscle insertion distance and LR muscle width were not correlated with deviation size. Only the MR muscle width was positively correlated with the deviation size. CONCLUSIONS: Insertion distances of the medial and LR muscles are not statistically different in ET, XT, and control patients. Only MR muscle width was affected by the size of the deviation in ET patients.

Choroidal Thickness in Strabismus and Amblyopia Cases.

PURPOSE: The aim of our study was to examine the effect of hypermetropia and anisometropic, exotropic, and esotropic amblyopia on choroidal thickness. METHODS: A prospective, cross-sectional, comparative study of 120 children under the age of 16 years was conducted. Choroidal thickness was measured in patients with hypermetropia, anisometropia, esotropia, exotropia, and controls. RESULTS: The mean subfoveal choroidal thickness in the control and hypermetropia groups was 323.9±69.0 µm and 348.9±64.5 µm, respectively. Mean choroidal thickness in amblyopic and fellow eyes was 387.4 and 351.9 µm in anisometropic, 353.8 and 338.7 µm in exotropic, 347.5 and 336.5 µm in esotropic, and 389.3 and 359.3 µm in esotropic+anisometropic groups, respectively. Choroid was significantly thicker in amblyopic eyes of anisometropic group compared to fellow (P=0.004) and control (P=0.03) eyes. The difference of choroidal thickness was not significant between both eyes and when compared to control eyes in the other groups. CONCLUSIONS: Anisometropic amblyopic eyes had thicker choroids compared to controls and fellow eyes. However the choroidal thickness was not significantly different between amblyopic and fellow eyes of esotropic or exotropic patients.

Infrequent Complications of Inferior Oblique Recession Surgery.

PURPOSE: To report the infrequent complications, including antielevation and adherence syndrome, after a unilateral and bilateral inferior oblique (IO) recession procedure and to discuss the possible causes. METHODS: A retrospective chart review was conducted for patients on whom unilateral or bilateral IO weakening surgeries were performed. RESULTS: Forty-three patients were included in the study. In 23 patients unilateral and in 20 patients bilateral IO weakening was performed. All patients underwent IO recession surgery. Mild limitation of elevation developed in two patients and adherence syndrome developed in one patient. All occurred after unilateral IO recession. No duction deficiency was observed in patients after bilateral IO recession. CONCLUSION: Antielevation and adherence syndrome can develop after unilateral IO recession surgery. Care should be taken not to tighten the neurofibrovascular bundle of the IO muscle during surgery.

Prediction of severe retinopathy of prematurity using the screening algorithm WINROP in preterm infants.

PURPOSE: To assess the sensitivity and specificity of weight gain, insulin-like growth factor 1 (IGF-1), and neonatal retinopathy of prematurity (WINROP) algorithm to predict proliferative retinopathy of prematurity (ROP), in a Turkish population of preterm infants. METHODS: The medical records of infants screened and monitored for ROP from 2007 to 2014 were analyzed retrospectively. Birth weights of infants born before 32 weeks' gestation were recorded on the WINROP online database system weekly until postmenstrual week 36. The sensitivity, specificity, and positive and negative predictive values of the WINROP algorithm were analyzed. RESULTS: A total of 223 infants were included. WINROP yielded a low-risk result in 106 infants (48%) and a high-risk result (red alarm) in the remaining 117 infants (53%). The sensitivity of the WINROP online system was found to be 84.3% (27/32), whereas its specificity was found to be 52.8% (101/191). The time between the first alarm and treatment was 8.59 ± 3.92 (2-15) weeks. Using this algorithm, 106 infants would not have needed eye examinations, possibly resulting in a 40% decrease in the total number of examinations. CONCLUSIONS: The WINROP online system is a valuable and easy-to-use monitoring system that could decrease the number of infant ROP examinations.

Comparison of Anterior Segment Parameters Obtained by Dual-Scheimpflug Analyzer Before and After Cycloplegia in Children.

PURPOSE: To assess the changes of anterior segment parameters with cycloplegia. METHODS: A cross-sectional study of healthy pediatric patients was performed. Anterior segment parameters were obtained by the Galilei Dual-Scheimpflug analyzer (Ziemer Group, Port, Switzerland) before and 40 minutes after the instillation of cyclopentolate. The effect of gender was evaluated. RESULTS: There were 43 boys and 50 girls with a mean age of 7.76 ± 2.7 years. There was a significant increase in anterior chamber depth, anterior chamber volume, and pupil diameter after the cycloplegia (P < .05). The anterior chamber angle increased after cycloplegia in the nasal, temporal, and inferior quadrants (P < .05), but not in the superior quadrant (P > .05). The mean values of anterior segment parameters were similar in both genders. CONCLUSIONS: The values of anterior chamber depth, anterior chamber volume, anterior chamber angle, and pupil diameter measured with the Galilei Dual-Scheimpflug analyzer increased significantly after cycloplegia. Gender did not have an effect on anterior segment parameters. [J Pediatr Ophthalmol Strabismus. 2016;53(4):234-237.].

Optic Nerve Head Parameters in a Turkish Population Over Forty Years of Age.

OBJECTIVES: To evaluate the optic disc area and cup area in a normal population over 40 years of age. MATERIALS AND METHODS: This prospective study was performed in Eskisehir. Fundus photographs were obtained using a nonmydriatic fundus camera. Planimetric measurements of the optic disc and cup area were performed with VK-2 digital imaging software. Optic nerve parameters were then compared between sex and age groups. RESULTS: A total of 3,038 subjects were evaluated. Mean age was 56.6±10.4 years (range 40-91 years). The median disc area of the subjects was 2.87 (2.53-3.23) mm2 in the right eyes and 2.89 (2.55-3.25) mm2 in the left eyes (p<0.001). The median cup area of the subjects was 0.46 mm2 (0.33-0.64 mm2) in the right eyes and 0.44 mm2 (0.33-0.61 mm2) in the left eyes (p<0.001). The differences in disc and cup area between male and female subjects were not statistically significant (p>0.05). CONCLUSION: We report the normal distribution of disc area and cup area measurements and their association with age and sex.

Esthesioneuroblastoma With Poor Outcome Despite Extensive Treatment.

Esthesioneuroblastoma is a rare malignant tumor of neuroectodermal origin. It usually presents with nonspecific symptoms, such as nasal obstruction, epistaxis, and pain, but has an aggressive course if the treatment is delayed. The authors report a case of esthesioneuroblastoma in a 47-year-old woman, treated with extensive surgical resection, radiotherapy, and chemotherapy. Despite intensive treatment, the patient developed a local recurrence with systemic metastasis and succumbed 4 months later.

Incidence of retinopathy of prematurity in the middle Black Sea region of Turkey over a 10-year period.

PURPOSE: To report the incidence of retinopathy of prematurity (ROP) in babies with a birth weight of ≤1750 g over a 10-year period in the north of Turkey. METHODS: The medical records of 2,365 preterm babies who had been referred for ophthalmological examination were retrospectively reviewed, and children with a birth weight of ≤1750 g were included. The incidence of ROP was compared between two successive 5-year periods: 2004-2008 and 2009-2013. RESULTS: A total of 1,565 babies were included: 624 in the first period and 941 in the second. The incidence of ROP significantly increased during the second period compared to the first (35.3% vs 48.2% [P < 0.001]). The number of patients who required treatment was 11.9% in the first period and 11.4% in the second (P = 0.768). CONCLUSIONS: Although the incidence of ROP increased during the latter period of study (2009-2013), the numbers of treatment-requiring cases were similar in both periods.

Pseudoexfoliation syndrome in chronic kidney disease patients.

This study was performed to determine whether chronic kidney disease (CKD) is associated with an increased risk of pseudoexfoliation (PEX) syndrome. This is an age-matched case control study evaluating frequency of PEX in patients over age 40 with the diagnosis of stage 1-4 CKD and those undergoing hemodialysis (HD). Subjects over age 40 with hypertension and/or diabetes mellitus (DM) and normal kidney functions were studied as a control group. CKD was diagnosed as decreased glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m(2) for at least 3 months. Study groups were arranged as group 1 consisting of HD receiving CKD patients, group 2 consisting of CKD patients who do not need HD and group 3 as a control. Demographic properties and the prevalence of PEX were evaluated and compared between groups. Because of the effect of DM on PEX occurrence, it was also evaluated after exclusion of diabetic patients. A total of 101 cases in group 1, 106 cases in group 2 and 117 cases in group 3 were included in the study. Pseudoexfoliation was found in 7 (6.9%) patients in group 1, 5 (4.7%) patients in group 2 and 7 (5.9%) patients in group 3 (p > 0.05). After exclusion of diabetic patients the prevalence of PEX changed as 4 (5.6%) in group 1, 2 (4.4%) in group 2 and 1 (1.8%) in group 3 (p > 0.05). In conclusion, CKD was not associated with increased prevalence of PEX in this study.

Paralytic strabismus and papilloedema caused by dural sinus thrombosis after bee sting.

A patient that developed paresis of the sixth cranial nerve and bilateral papilloedema after the bee sting to the periocular area is presented. Magnetic resonance venography showed a unilateral transverse and sigmoid sinus thrombosis. The patient was successfully treated with anticoagulation and intracranial pressure lowering treatment.

Hyaluronidase in ophthalmic evisceration surgery.

BACKGROUND: To research the effectiveness of hyaluronidase in evisceration surgery. METHODS: A total of 34 patients were studied as three groups: conventional surgery group (n = 13); isotonic fluid group (n = 8); and hyaluronidase group (n = 13). Hyaluronidase and isotonic fluid were introduced into the uveo-scleral space. Intraocular content was removed, if possible by a one-scoop method, with the aid of a spoon. RESULTS: Removing all the intraocular content as a one-scoop method was achieved in 10 of 13 (77%) in the hyaluronidase group and four of eight (50%) in the isotonic fluid group. The one-scoop method was not possible in any case without the introduction of fluid. The mean durations for the evisceration procedure were 32, 36.6 and 40.5 min in the three groups, respectively (P < 0.05). CONCLUSIONS: Using hyaluronidase in evisceration surgery greatly facilitates and speeds up the removal of all the intraocular content in ophthalmic evisceration surgery.