The Short-Term Effect of 1% Tropicamide Drop on Pupillary Diameter and Intraocular Pressure Change in Patients With Pseudoexfoliation Material.

PRCIS: In this study, in patients with pseudoexfoliation syndrome (PXS) or glaucoma, changes in intraocular pressure (IOP) and pupil size after 1% tropicamide used for pupil dilation, compared with healthy patients were quantitatively demonstrated up to 4 hours after dilation. PURPOSE: The purpose of this study was to evaluate pharmacological dilatation with one drop of 1% tropicamide on pupillary diameter and IOP changes in patients with PXS and glaucoma (PXG). MATERIALS AND METHODS: Eighty-two patients with PXS, 78 Patients with PXG, and 35 healthy subjects were included in the study. PXG and PXS were diagnosed based on IOP assessment, corneal pachymetry, optic disc examination, visual field testing, and peripapillary retinal nerve fiber analysis. IOP and the diameter of pupil size were measured before dilatation and at postdilatation first, second, and fourth hours. RESULTS: The mean pupillary diameter values at postdilatation second and fourth hours were statistically significantly different between the patients with PXS and PXG ( P <0.001, for each). Also, there were significant differences between the PXS group and the control group in terms of the mean pupillary diameter values at predilatation and postdilatation at the first hour and postdilatation second hour ( P =0.007, <0.001, respectively). The mean pupillary diameter at all times was statistically significantly different between PXG and control groups ( P <0.001 for each). Significant IOP increases were observed in all groups after dilatation. The mean IOP at predilatation and postdilatation fourth hour was statistically significantly different between PXG and PXS groups ( P =0.042, <0.001, respectively). Whereas the mean IOP at predilatation, postdilatation first hour, postdilatation second hour, and postdilatation fourth hour were statistically significantly different between PXG and control group ( P <0.001 for each). CONCLUSIONS: Significant IOP increases have been observed in our study with 1% tropicamide in the PXG and PXS groups, with the peak effect at the second hour in the postdilatation period. Furthermore, the mean pupil diameter was found to be significantly lower in PXG patients compared with the control group.

The ganglion cell complex damage in coronary artery disease.

PURPOSE: This study aims to investigate the correlation between macular thickness, retinal nerve fiber layer thickness, ganglion cell complex thickness, and Gensini scores in patients who have undergone coronary angiography, using spectral-domain optical coherence tomography. METHODS: We retrospectively evaluated optical coherence tomography results from patients who had undergone coronary angiography between January 2019 and January 2021 due to coronary artery disease, with angiography performed within one month of the optical coherence tomography examination. Based on their Gensini scores, patients were classified into two groups: mild coronary artery disease (Gensini score ≤ 20, Group 1) and severe coronary artery disease (Gensini score > 20, Group 2). RESULTS: Group 1 comprised 28 patients with an average age of 61.3 ± 10.2, while Group 2 consisted of 25 patients with an average age of 65.4 ± 9.6. While there was no statistically significant difference found in retinal nerve fiber layer and macular thickness between the groups, the ganglion cell complex thickness was significantly thinner in Group 2 in the inner superior temporal (112.55 ± 34.12 µm vs. 99.68 ± 37.81 µm, p = 0.026), inner superior nasal (121.14 ± 32.92 µm vs. 108.36±24.53 µm, p = 0.012), inner inferior nasal (120.81 ± 32.34 µm vs. 108.45 ± 12.53 µm, p = 0.048), and superior (99.11 ± 25.91 µm vs. 88.77 ± 16.75 µm, p = 0.020) regions. Furthermore, a significant negative correlation was observed between the Gensini score and the ganglion cell complex thickness in both the inner superior nasal and superior regions. CONCLUSION: Compared to patients with mild coronary artery disease, those with severe disease exhibited a significant decrease in ganglion cell complex thickness in the superior and inner superior nasal regions.

Comparison of visual outcomes between 120-µm and 140-µm cap thicknesses 12 months after small incision lenticule extraction.

To compare visual and refractive outcomes as well as changes in high-order aberrations in patients with 120- versus 140-µm cap thicknesses 12 months after small incision lenticule extraction. Ninety-four patients were randomized to receive small incision lenticule extraction with either a 120-µm cap thickness (n = 47) or a 140-µm cap thickness (n = 47) to treat myopia or myopic astigmatism, if not both. In an analysis of right eyes only during the 12-month follow-up period, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive outcomes, and high-order aberrations were evaluated. The distribution of patients by age and sex between the groups did not differ significantly (P = .803 and P = .680, respectively). CDVA, spherical and cylindrical refraction, and changes in total high-order aberration, spherical aberration, coma, and trefoil were similar between the groups at 6 and 12 months, postoperatively. However, UDVA was statistically significantly higher in patients with 140-µm cap thicknesses than with 120-µm cap thicknesses at 6 and 12 months postoperatively (P < .001 and P < .001, respectively). Patients with 140-µm cap thickness showed greater improvement in UDVA than ones with 120-µm cap thickness at 12-month follow-up (P = .005). Both 120- and 140-µm cap thicknesses in small incision lenticule extraction were safe and effective thicknesses for correcting myopia or myopic astigmatism. The patients with 140-µm cap thickness had better improvement in UDVA after 12-month follow-up compared to patients with 120-µm cap thickness.

Acquired Comitant Esotropia in Children and Young Adults: Clinical Characteristics, Surgical Outcomes, and Association With Presumed Intensive Near Work With Digital Displays.

PURPOSE: To describe the clinical characteristics and surgical outcomes of acquired comitant esotropia with symptomatic diplopia. METHODS: The clinical features and surgical outcomes of 27 patients with diplopia due to acquired comitant esotropia were retrospectively reviewed. Exclusion criteria were a history of prematurity, cerebral palsy, head trauma, or febrile illness before the onset of acquired comitant esotropia, incomitant strabismus, accommodative spasm, and divergence paralysis. Neurological evaluation and neuroimaging was normal in all patients. RESULTS: Mean age at onset of esotropia and diplopia was 17.8 ± 10.3 years (range: 6 to 44 years). Eighteen patients had simple myopia (range: -0.25 to -7.75 diopters [D]), 5 patients had hypermetropia (range: 0.50 to 1.50 D), and 4 patients had emmetropia. The angle of deviation prior to surgery was 35.6 ± 10.3 prism diopters (PD) for far and 38.0 ± 10.5 PD for near fixation. Twenty-three patients (85%) were prism responders. A history of excessive near work (≥ 4 hours a day) with digital displays was present in 21 (78%) patients. Diplopia resolved and some level of stereovision was achieved in all patients postoperatively. Three patients had recurrence of esotropia in long-term follow-up. CONCLUSIONS: The differentiation of a serious pathology from a straightforward optically or medically treatable condition in patients with a subacute or chronic history of diplopia is challenging for the clinician. The recognition of acquired comitant esotropia due to presumed intensive near activities with digital display may avoid time-consuming and costly laboratory investigations. Most of the patients in this series were prism responders and surgery for the prism-adapted angle was successful in restoring binocular vision. [J Pediatr Ophthalmol Strabismus. 2020;57(4):251-256.].