Ocular Inflammation and Depression: Ophthalmologists' Perspective.

Inflammation may act throughout all the systems in the body including the brain and contribute to many pathological processes. This mini-review starts with a brief overview of the literature in respect with the relation between ocular inflammation and depression. In addition, the discussion is mainly condensed on relevant studies about two ocular diseases: uveitis and dry eye. With this review, we aim to summarize the current evidence, potential mechanisms and to provide a clinical point of view to patients with ocular inflammatory diseases who may also be prone to concurrent depression and depressive symptoms.

Normative values for optical coherence tomography parameters in healthy children and interexaminer agreement for choroidal thickness measurements.

PURPOSE: To (a) determine the normative values for optical coherence tomography (OCT) parameters such as central macular thickness, retinal nerve fiber layer thickness, and choroidal thickness in healthy children; (b) investigate the relationships of these parameters with axial length, central corneal thickness, refractive errors, and intraocular pressure; and (c) determine interexaminer agreement for choroidal thickness measurements. METHODS: In this cross-sectional study, 120 healthy children aged 8-15 years underwent detailed ophthalmological examination and OCT measurements. Choroidal thickness was measured at three separate locations by two independent examiners. RESULTS: The mean global retinal nerve fiber layer thickness was 98.75 ± 9.45 µm (79.0-121.0). The mean central macular thickness was 232.29 ± 29.37 µm (190.0-376.0). The mean subfoveal choroidal thickness obtained by examiner 1 was 344.38 ± 68.83 µm and that obtained by examiner 2 was 344.04 ± 68.92 µm. Interexaminer agreement was between 99.6%-99.8% for choroidal thickness at three separate locations. Central macular thickness increased with axial length (r=0.245, p=0.007). Choroidal thickness increased with age (r=0.291, p=0.001) and decreased with axial length (r=-0.191, p=0.037). Global retinal nerve fiber layer thickness decreased with axial length (r=-0.247, p=0.007) and increased with central corneal thickness (r=0.208, p=0.022). Global retinal nerve fiber layer thickness positively correlated with choroidal thickness (r=0.354, p<0.001). Global retinal nerve fiber layer thickness (r=0.223, p=0.014) and choroidal thickness (r=0.272, p=0.003) increased with the spherical equivalent (D). CONCLUSIONS: Optical coherence tomography parameters showed a wide range of variability in children. Retinal nerve fiber layer thickness, central macular thickness, and choroidal thickness were found to be either inter-related or correlated with age, central corneal thickness, axial length, and refractive errors. Furthermore, manual measurements of choroidal thickness showed high interexaminer agreement. Because normative values for optical coherence tomography parameters differed in children, the measurements should be interpreted according to an age-appropriate database.

Normative values for optical coherence tomography parameters in healthy children and interexaminer agreement for choroidal thickness measurements / Valores normativos de parâmetros de tomografia de coerência óptica em crianças saudáveis e concordância interexaminador de medidas de espessura coroidal

ABSTRACT Purpose: To (a) determine the normative values for optical coherence tomography (OCT) parameters such as central macular thickness, retinal nerve fiber layer thickness, and choroidal thickness in healthy children; (b) investigate the relationships of these parameters with axial length, central corneal thickness, refractive errors, and intraocular pressure; and (c) determine interexaminer agreement for choroidal thickness measurements. Methods: In this cross-sectional study, 120 healthy children aged 8-15 years underwent detailed ophthalmological examination and OCT measurements. Choroidal thickness was measured at three separate locations by two independent examiners. Results: The mean global retinal nerve fiber layer thickness was 98.75 ± 9.45 μm (79.0-121.0). The mean central macular thickness was 232.29 ± 29.37 μm (190.0-376.0). The mean subfoveal choroidal thickness obtained by examiner 1 was 344.38 ± 68.83 μm and that obtained by examiner 2 was 344.04 ± 68.92 μm. Interexaminer agreement was between 99.6%-99.8% for choroidal thickness at three separate locations. Central macular thickness increased with axial length (r=0.245, p=0.007). Choroidal thickness increased with age (r=0.291, p=0.001) and decreased with axial length (r=-0.191, p=0.037). Global retinal nerve fiber layer thickness decreased with axial length (r=-0.247, p=0.007) and increased with central corneal thickness (r=0.208, p=0.022). Global retinal nerve fiber layer thickness positively correlated with choroidal thickness (r=0.354, p<0.001). Global retinal nerve fiber layer thickness (r=0.223, p=0.014) and choroidal thickness (r=0.272, p=0.003) increased with the spherical equivalent (D). Conclusions: Optical coherence tomography parameters showed a wide range of variability in children. Retinal nerve fiber layer thickness, central macular thickness, and choroidal thickness were found to be either inter-related or correlated with age, central corneal thickness, axial length, and refractive errors. Furthermore, manual measurements of choroidal thickness showed high interexaminer agreement. Because normative values for optical coherence tomography parameters differed in children, the measurements should be interpreted according to an age-appropriate database.

RESUMO Objetivo: Determinar valores normativos para parâmetros de tomografia de coerência óptica consistindo em espessura macular central, espessura da camada de fibra nervosa da retina e espessura coroidal em crianças saudáveis, para investigar suas relações com o comprimento axial, espessura corneana central, erros refractivos e pressão intraocular e determinar a concordância interexaminador para medidas de espessura coroidal. Métodos: um total de 120 crianças saudáveis com idade entre 8 e 15 anos foram submetidas a exame oftalmológico detalhado e a medições de tomografia de coerência óptica em uma configuração de estudo transversal. A espessura coroide foi medida por dois examinadores independentes em 3 pontos distintos. Resultados: A espessura global media da camada de fibra nervosa da retina foi de 98.75 ± 9.45 μm (79.0-121.0). A espessura macular central media foi de 232.29 ± 29.37 μm (190.0-376.0). A espessura coroidea subfoveal media foi de 344.38 ± 68.83 μm medida pelo examinador 1 e 344.04 ± 68.92 μm medida pelo examinador 2. A concordância foi entre 99.6-99.8% para a espessura coroidal em 3 pontos distintos. Verificou-se que a espessura macular central aumentava com o comprimento axial (r=0.245, p=0.007). A espessura da coroide aumentou com a idade (r=0.291, p=0.001) e diminuiu com o comprimento axial (r=-0.191, p=0.037). A espessura global da camada de fibras nervosas da retina diminuiu com o comprimento axial (r=-0.247, p=0.007) e aumenta com a espessura central da córnea (r=0.208, p=0.022). A espessura global da camada de fibras nervosas da retina foi correlacionada positivamente com a espessura coroidal (r=0.354, p<0.001). A espessura global da camada de fibras nervosas da retina (r=0.223, p=0.014) e a espessura coroide (r=0.272, p=0.003) aumentaram com o equivalente esférico (D). Conclusões: os parâmetros de tomografia de coerência óptica parecem mostrar uma ampla gama de variabilidade em crianças. A espessura da camada de fibra nervosa da retina, a espessura macular central, a espessura coroidea estão inter-relacionadas ou correlacionadas com a idade, espessura corneana central, comprimento axial e erros refractivos. Além disso, as medidas manuais da espessura coroidea apresentaram alta concordância entre examinadores. Deve-se ter em mente que os valores normativos dos parâmetros da tomografia de coerência óptica diferem em crianças, portanto, as medidas devem ser interpretadas de acordo com uma determinada base de dados apropriada para idade.

Effects of GH/IGF-I Axis on Retinal Vascular Morphology: Retinal Vascular Characteristics in a Clinical Setting with Severe IGF-I Deficiency.

BACKGROUND: The purpose of this study was to assess retinal vascular characteristics of patients with Laron syndrome (LS) as a genetic model of IGF-I deficiency before and after rhIGF1/IGFBP3 treatment and to compare them with healthy controls. METHODS: A total of 28 subjects (11 LS, and 17 controls) were enrolled. Patients with LS received combined rhIGF1/rhIGFBP3 1-2 mg/kg/d in a single dose and digital fundus imaging was performed. The number of branching points and tortuosity of retinal vessels were studied. Pre- and post-treatment findings were compared with each other and with controls. RESULTS: The number of branching points was significantly lower in patients with LS in comparison to controls (12.73 ± 3.41, and 17.47 ± 5.82 respectively, p = 0.012). This difference persisted after treatment (12.09 ± 2.66 post-treatment LS versus controls, p = 0.017). Tortuosity indices of nasal arteries (NA) were significantly less in LS than that of controls (upper NA 1.07 ± 0.04 and 1.12 ± 0.06 respectively p = 0.022; lower NA 1.07 ± 0.03 and 1.13 ± 0.07 respectively, p = 0.004). This difference also persisted following treatment (p < 0.05). Remaining vessels did not differ in tortuosity index. There was no significant difference of tortuosity index and number of branching points before and after treatment in patients with LS. CONCLUSION: Retinal vascular development may be adversely affected in the setting of severe IGF-I deficiency confirming a major role for GH/IGF-I axis during retinal vascular development in humans antenatally. Resolution of IGF-I deficiency following birth using rhIGF1, however, may not reverse these changes, suggesting that IGF-I may be necessary but insufficient by itself for postnatal angiogenesis.

Fundus autofluorescence and optical coherence tomography findings in glutathione synthetase deficiency.

We report the autofluorescence pattern and optical coherence tomography (OCT) characteristics in a 6-year-old boy with glutathione synthetase deficiency. The patient underwent complete ophthalmological examination, including full-field electroretinography, visual evoked potentials, fundus autofluorescence, and OCT imaging. Electrophysiological studies showed time-delay and subnormal responses. Fundus autofluorescence imaging revealed increased parafoveal autofluorescence compared to normal, and OCT showed alteration of photoreceptor and retinal pigment epithelium layers in the parafoveal region.

Ocular surface alterations in blepharospasm patients treated with botulinum toxin A injection.

PURPOSE: To evaluate ocular surface changes secondary to periocular botulinum toxin A injection in patients with essential blepharospasm. METHODS: Thirteen eyes of 13 patients with essential blepharospasm who underwent periocular botulinum toxin A injection were included in this prospective study. Patients were evaluated prior to and at 2-week and 1-, 3-, and 6-month time points following injections. Ocular surface tests were carried out in the order of tear break-up time (TBUT), lissamine green (LG) staining, Schirmer I test with anesthesia, and ocular surface disease index (OSDI) questionnaire for all patients. The Friedman test with Conover post hoc method was used for statistical comparisons of values at different time points. RESULTS: The TBUT was found to be increased at 1 month after the injection (8.5 ± 2.1; p = 0.018) and decreased below baseline levels (6.4 ± 2.1) at the 6-month visit (5.7 ± 2.0; p = 0.018). None of the Schirmer test values at follow-up visits were significantly different as compared to baseline levels (11.3 ± 5.5), although the 2-week measurement (14.3 ± 5.6) was significantly higher as compared to that at the 6-month follow-up visit (9.6 ± 4.9; p = 0.034). There was also a significant decrease in LG staining scores at 2-week (0.6 ± 0.4; p = 0.012) and 1-month (0.6 ± 0.4; p = 0.012) time points compared to the baseline levels (1.1 ± 0.6). The OSDI scores improved at 2-week (5.4 ± 6.8; p<0.001), 1-month (3.2 ± 5.1; p<0.001), 3-month (2.5 ± 4.4; p<0.001), and 6-month (5.5 ± 5.4; p<0.001) time points as compared to baseline levels (11.6 ± 8.5). CONCLUSIONS: Botulinum toxin A injection appears to have a positive but temporary effect on ocular surface parameters in patients with blepharospasm.

Bilateral optic neuritis--the only ocular finding in a case of subacute sclerosing panencephalitis.

Subacute sclerosing panencephalitis is a rare disease of central nervous system caused by defective measles virus. Chorioretinitis with macular involvement is the mostly observed ocular finding in the disease. Other reported ocular findings in the disease are cortical blindness, hemianopsia, nystagmus, extraocular muscle paresis and optic atrophy. We present a rare case of subacute sclerosing panencephalitis with isolated bilateral optic neuritis as the only ocular finding without macular involvement.

Functional Amblyopia and Deficient Binocular Vision as Initial Clinical Features in Duane's Syndrome.

PURPOSE: To investigate and report the clinical characteristics at initial presentation in patients who had Duane Syndrome, especially binocular vision and functional amblyopia. METHODS: The medical files of patients with Duane's syndrome were reviewed. The main outcome measures of the study were the initial clinical characteristics including amblyopia and associated risk factors including deficiences of binocular vision. RESULTS: The review identified 99 patients with Duane Syndrome. The median age of patients was 6 years. The frequency of amblyopia at initial presentation was 23 percent. Forty-five patients had measurable stereopsis and 58 patients had binocular vision fusion. CONCLUSIONS: Amblyopia and altered binocular function are important among the clinical features of Duane Syndrome which should be highlighted at initial examination.

Superior oblique surgery: when and how?

BACKGROUND: The purpose of this paper is to review different types of superior oblique muscle surgeries, to describe the main areas in clinical practice where superior oblique surgery is required or preferred, and to discuss the preferred types of superior oblique surgery with respect to their clinical outcomes. METHODS: A consecutive nonrandomized retrospective series of patients who had undergone superior oblique muscle surgery as a single procedure were enrolled in the study. The diagnosis, clinical features, preoperative and postoperative vertical deviations in primary position, type of surgery, complications, and clinical outcomes were reviewed. The primary outcome measures were the type of strabismus and the type of superior oblique muscle surgery. The secondary outcome measure was the results of the surgeries. RESULTS: The review identified 40 (20 male, 20 female) patients with a median age of 6 (2-45) years. Nineteen patients (47.5%) had Brown syndrome, eleven (27.5%) had fourth nerve palsy, and ten (25.0%) had horizontal deviations with A pattern. The most commonly performed surgery was superior oblique tenotomy in 29 (72.5%) patients followed by superior oblique tuck in eleven (27.5%) patients. The amount of vertical deviation in the fourth nerve palsy and Brown syndrome groups (P = 0.01 for both) and the amount of A pattern in the A pattern group were significantly reduced postoperatively (P = 0.02). CONCLUSION: Surgery for the superior oblique muscle requires experience and appropriate preoperative evaluation in view of its challenging nature. The main indications are Brown syndrome, fourth nerve palsy, and A pattern deviations. Superior oblique surgery may be effective in terms of pattern collapse and correction of vertical deviations in primary position.

Retinopathy of prematurity: a nationwide survey to evaluate current practices and preferences of ophthalmologists.

PURPOSE: To emphasize the demographic and occupational characteristics of ophthalmologists primarily involved in retinopathy of prematurity (ROP) care and to ascertain their practices and preferences. METHODS: A questionnaire was sent to all Turkish ophthalmologists known to be primarily involved in ROP. They were asked about personal and occupational characteristics, practices and preferences related to ROP care, and for their proposals related to ROP training. RESULTS: Seventy questionnaires were sent, of which 63 (90%) were returned. A total of 44 respondents reported performing laser and 13 vitreoretinal surgery. Preferred treatment was transpupillary laser photocoagulation (54.5%), mostly performed in the operating theater (84.1%) under general anesthesia (72.7%). Only 19 (30.2%) reported intravitreal injection of vascular endothelial growth factor inhibitors (anti-VEGF). Ophthalmologists from university hospitals, trained in retina during fellowship, and performing treatment for ROP more commonly performed anti-VEGF injection. Most of them studied ROP after residency and 76.2% think that ROP training during residency is inadequate for clinical practice. CONCLUSION: This survey reveals considerable variation among Turkish ROP specialists regarding ROP care. The survey data are critical in order to develop quality improvement and help in planning more effective future programs for ROP care in terms of training.

Intravitreal injection of methotrexate in an experimental rabbit model: determination of ultrastructural changes.

PURPOSE: To investigate the ultrastructural changes of the rabbit retina induced by intravitreal methotrexate injection. MATERIALS AND METHODS: Ten New Zealand white rabbits were enucleated bilaterally at different time periods after intravitreal methotrexate injection. One rabbit was used as control group and one rabbit was used as intact group. Histopathological examinations were performed under light and electron microscopy. Early (within first three days after injection) and long-term (one month after serial injections) effects of intravitreal methotrexate on the retina were investigated. RESULTS: Retinal edema, vacuolization, and disintegration of mitochondria of the retinal cells were observed as early changes. The main long-term effects after serial injections were edema in the photoreceptor, inner nuclear, and ganglionic cell layers. Cellular disorganisation was seen on light microscopy. Electron microscopic examination revealed mitochondrial degeneration and vacuole formation in retinal cells, nuclear degeneration in outer nuclear layer, and membranous whorl formation in photoreceptor and nerve fiber layers. CONCLUSIONS: High dose intravitreal methotrexate injection may cause significant ultrastructural changes in the rabbit retina in varying severity. This finding may highlight the potential side effects of methotrexate on human retina in higher doses.

An unexpected delayed complication of cataract surgery: retinal detachment secondary to capsular tension ring dislocation.

We aim to present a case of retinal detachment secondary to capsular tension ring dislocation following cataract surgery. A 45-year-old man who underwent cataract surgery 2 years previously presented with decreased vision in his left eye. The patient's posterior capsule was intact with a well-located posterior chamber intraocular lens. Fundus examination revealed retinal detachment with retinal tears, and a capsular tension ring located around the tear was noticed during pars plana vitrectomy; it was removed through the sclerotomy site. In conclusion, dislocation of the capsular tension ring is a rare and unexpected complication of cataract surgery. Although the integrity of the posterior lens capsule is partially preserved, the ring may shift through a small tear in the bag even during its placement, and may cause retinal tears, retinal detachment or just remain silently suspended in the vitreous.

Sequential presentation of bilateral Brown syndrome.

Brown syndrome, characterized by a limitation of elevation in adduction and positive forced duction testing, is usually unilateral but occurs bilaterally in 10% of all cases. It may present as a congenital condition in one eye and develop in the other eye with no apparent cause. We present a case of bilateral Brown syndrome in which the right eye became involved within 1 year of surgery on the left eye for congenital Brown syndrome.

Bilateral acute idiopathic frosted branch angiitis in a pregnant woman.

PURPOSE: To present a case of frosted branch angiitis in a pregnant woman. METHODS: A 27-week pregnant 18-year-old woman was presented with bilateral decreased visual acuity. Fundoscopy showed typical appearance of frosted branch angiitis. RESULTS: A good spontaneous clinical improvement was observed during systemic evaluation. No treatment was started. CONCLUSION: Frosted branch angiitis may be seen during pregnancy, without any associated underlying disease, and can be resolved without any intervention. The treatment may not be necessary for some cases.